Table 2 Clinical and histopathological characteristics of the main leprosy lesions considered as diagnostic hypotheses that resulted in biopsies with a subsequent diagnosis of dermatofibromas originating in leprosy lesions
Relapse | T1Ra (RR)b | T2Rc (ENL)d | Histoid leprosy | Drug resistance | |
|---|---|---|---|---|---|
Course | Recurrence 1 year or more after withdrawal of treatment | Usually within 6 months of withdrawal of treatment; in recurrent reactions, up to 2 years | Can occur any time during the course of leprosy, but is most common within 1 year of starting PCT | Patients who discontinued treatment or had resistance to sulfone | Initial amelioration followed by halt or worsening |
Leprosy lesions | All types | BT, BB, BL | LL side (LL and BL) | LL side (LL and BL) | LL side (LL and BL) |
Skin lesions | Increase in size and extent of existent lesion(s); new lesion(s); reappearance of lesions over old lesions; ulcerations not seen | Existing lesions become tumid and erythematous; distribution: locations of existing lesions; ulcerations seen in severe reactions | New erythematous dermal and/or subcutaneous nodules; painful and tender; distribution: upper and lower extremities, trunk, face | Skin-colored papules and nodules; bacillary proliferation and morphologically solid bacilli within fusiform macrophages | Appearance of new lesions with bacillary proliferation and morphologically solid bacilli |
Nerves | Nerve involvement; no spontaneous pain; tenderness on pressure; sensory and motor deficits slow and creeping; bacillary proliferation | Acute painful neuritis; nerves exquisitely tender; nerve “abscess” (caseous necrosis); sudden paralysis of muscles and increase in extent of sensory loss | Similar to T1R, but with influx of neutrophils and formation of microabscesses and absence of caseous necrosis | None | Bacillary proliferation |
Treatment | Retreatment with standard PCT or drug change if resistance is detected | Prednisone (start at 0.5–1.0 mg/kg) NSAIDs Azathioprine Cyclosporine | Thalidomide (start at 100–200 mg daily) Clofazimine Prednisone Pentoxifylline TNF-alfa inhibitors | Retreatment with standard PCT or drug change if resistance is detected | Retreatment. New drugs are used according to the definition of which of them previously used resulted in resistance by M. leprae |