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THROUGH THE LENS
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 162  

Mid-borderline leprosy


1 Department of Microbiology, Kasturba Medical College, Mangalore, India
2 Department of Dermatology, Yenepoya Medical College, Mangalore, India

Date of Web Publication17-Apr-2013

Correspondence Address:
Manjunath M Shenoy
Department of Dermatology, Yenepoya Medical College, Mangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.110647

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How to cite this article:
Shenoy SM, Shenoy MM. Mid-borderline leprosy. Indian Dermatol Online J 2013;4:162

How to cite this URL:
Shenoy SM, Shenoy MM. Mid-borderline leprosy. Indian Dermatol Online J [serial online] 2013 [cited 2019 Dec 15];4:162. Available from: http://www.idoj.in/text.asp?2013/4/2/162/110647

A 43-year-old male presented with asymptomatic cutaneous lesions chiefly involving the face, trunk, forearms and legs for the past six months. As the older lesions gradually enlarged, new lesions appeared. Examination revealed multiple asymmetrically distributed, annular, erythematous, indurated plaques with sharply punched out inner margins with normal skin in the centre and sloping outer margins. Irregular lesions were also seen. The right greater auricular and bilateral ulnar nerves were thickened and non-tender. Altered tactile sensations were demonstrable over the lesions on the extremities, but no motor loss was observed. Skin smears from the ear lobe and from an indurated plaque was positive for M.leprae. Based on the characteristic morphology of the lesions and other clinical findings, a diagnosis of mid-borderline or borderline-borderline (BB) leprosy was made. It appeared to be a case downgrading borderline leprosy and the patient was treated with standard MB MDT, to which he responded well.

BB leprosy is the immunologic midpoint in the fascinating clinical spectrum of the granulomatous disease. It is the most unstable and uncommon form. [1] These patients upgrade or downgrade to a more stable clinical form at the earliest. Cutaneous lesions are characteristically annular plaques with sharp interior and exterior borders [Figure 1] and [Figure 2]. [2] Large plaques with islands of clinically normal skin within the plaques give rise to a "Swiss cheese" appearance. [2] Lesions are numerous but are asymmetrical. Determining the type of leprosy is not based on clinical features alone. It involves the histological, bacteriological and immunological facets too, and these objectives seemed to have been met with in Ridley-Jopling classification. [3] Consistency among clinical, histological, bacteriological and immunological parameters is perhaps less than 50%. [3] Hence, identifying characteristic cutaneous lesions is useful for the classification of leprosy.
Figure 1: Annular plaque with sharp inner margin and sloping outer margins

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Figure 2: Annular and irregular plaques with normal skin in the centre

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   References Top

1.Sharma VK. Leprosy: Classification and clinical features. In: Valia RR, editor. Textbook and Atlas of Dermatology, vol. 2. Mumbai: Bhalani publishing house; 2001. p. 1578-603.  Back to cited text no. 1
    
2.Rea TH, Modlin RL. Leprosy. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's Dermatology in General Medicine. vol. 1. Philadelphia: McGraw-Hill; 2008. p. 1786-96.  Back to cited text no. 2
    
3.Majumdar S, Srivastava G, Kumar P. Clinicohistological disparity in leprosy. Indian J Dermatol Venereol Leprol 2003;69:178-9.  Back to cited text no. 3
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