Clinical and histopathological features in lepra reaction: a study of 50 cases

• Published in: International Journal of Research in Dermatology Vol. 5; no. 2; p. 382
• Main Authors: Shah, Urvi H., Jadwani, Monal M., Raju, Sahana P., Ladani, Pranav H., Bhuptani, Neela V.
• Format: Journal Article
• Language: English
• Published: 26.04.2019
• ISSN: 2455-4529; 2455-4529
• DOI: 10.18203/issn.2455-4529.IntJResDermatol20191766

Background: Lepra reactions remain a major persistent problem in leprosy. Type 1 and type 2 (erythema nodosum leprosum-ENL) reactions are the major causes of nerve damage and permanent disabilities. Diagnosing lepra reactions correctly is important for timely institution of therapy to prevent and treat disability and morbidity. Aim and objectives of the study were to make detailed observations on clinical and histopathological features of type1 and type 2 lepra reactions. Methods: In this study we included 50 patients diagnosed during a 1-year period as lepra reactions based on clinic-histopathological corelation. Results: Out of the 50 patients, 4 were of type 1 reaction and 46 of type 2 reaction from which recurrence was more commonly seen with type 2 reactions. The most consistent histopathological findings in type1 reaction were periadnexal inflammatory infiltrates (100%) and lymphocytes in granuloma (100%), followed by papillary dermal edema and intercellular edema within granuloma (75%). Surprisingly, folliculotropism of and lymphocytic panniculitis was seen in 50% cases. In ENL, the most common histological findings were periadnexal inflammatory infiltrates (95.6%), presence of neutrophils within the granuloma (86.9%), foamy macrophages followed by papillary dermal edema (69.5%), and neutrophilic panniculitis (43.4%). Vasculitis like changes was noted in only 46% cases. Conclusions: Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis are frequent in type1 reactions while neutrophilic panniculitis is common with ENL.