By Salvatore Noto, Pieter A M Schreuder
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Additional resources for Diagnosis of Leprosy
Skin patch with loss of sensation; 2. enlarged peripheral nerve; 3. positive slit-skin smear. 21 The leprosy spectrum according to the Ridley and Jopling classification tuberculoid leprosy BI borderline leprosy TT BT BB -- - -, 2+, 3+ BL 3+, 4+ lepromatous leprosy LL 5+, 6+ (1+,2+) BT BB BL BI -+ = = = = = = borderline tuberculoid leprosy mid borderline leprosy borderrline lepromatous leprosy bacteriological index negative degree of positivity 22 Nerve damage in leprosy 1. dermal nerves; 2. cutaneous nerves; 3.
24 How to diagnosis leprosy • history taking; • physical assessment; and • laboratory investigations. 25 • Slides 27 and 28 show the importance of the source of light in clinical examination 26 Skin lesions must be examined in a good light BUT NOT direct sunlight Indeterminate leprosy. Compare these photos, same patient, same day, same verandah! B. examined in bright sunlight. Note shadows and that lesion can hardly be identified. A. a well defined edge for part of the lesion, is apparent. It is slightly erythematous, when seen in good light, but not in sun.
Demonstrate 3. Test when the patient comprehends fully Courtesy of: S Noto 4 • Hypopigmentation • Distribution • Margins • Streaming and satellite lesions Loss of sensation? Yes Leprosy Courtesy of: S Noto 5 • Distribution • Margins • Streaming and satellite lesions • Surface is dry Loss of sensation? Yes. Leprosy Courtesy of: S Noto 6 Addendum The sweat and histamine tests 7 Loss of sweating in hypopigmented leprosy macules Borderline leprosy The big leprosy lesion (arrow) is definitely dry while the normal skin is shiny from the reflection from the moisture of the sweat.