No Hypopigmented Lesion, No Nerve Thickening, But Its Leprosy!

Ref.:   No Hypopigmented Lesion, No Nerve Thickening, But Its Leprosy!
From:

1.
H K Kar, New Delhi, India

2.

D Palande, Kurichikuppam, Pondicherry, India

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1.

Dear Dr Noto,

I appreciate to note the comment from Dr Warren on article "No hypo-pigmented lesion, no nerve thickening, but leprosy" by A Singh et al (Indian J Dermatology, 2012.).  There is a great change in clinical presentation of lepromatous (LL) leprosy in India, must be the same in Brazil, the two most leprosy populated countries.  It requires a lot of data generation from the published and unpublished documents for the future leprologists, dermatologists and physician especially for early diagnosis of LL through suspecting clinically and confirming on slit skin smear (SSS) examination.  

For early LL, especially in the stage of early infiltration in the skin without any nerve involvement clinically, only a doctor with sharp clinical acumen can suspect this stage when he/she examines the patient in a natural light and confirm with SSS.  Recently, very unusual presentations of LL have been documented with single nodular lesion, single nerve lesion, and few evanescent ENL lesions.
Our teaching program on leprosy should focus on these aspects to our younger generation medical students in graduate and post graduate level.

Regards,

Dr (Prof.) H K Kar
Dean, PGIMER, Dr R M L Hospital
Consultant & HOD
Department of Dermatology, STD & Leprosy
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001

2.

Dear Dr Noto,

I very much appreciate and would like to repeat what Dr. Grace has written [LML May 28^th, 2012] especially the sentence:-

“This is a timely reminder and one wonders how many of these patients are treated for some other disease or just not treated till the leprosy is definite and that often means that deformity or disability will result.  Also the patients most likely to have this type of lesion are those at lepromatous end of spectrum and so most likely to transmit the disease to their contacts; even if they are not manifesting obvious lesions”.

Dinkar D. Palande