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SKIN & VD 4-2-2013 CLASSIFICATION OF LEPROSYI. RIDLEY AND JOPLING’S CLINICAL CLASSIFICATION OF LEPROSYTUBERCULOID LEPROSY (TT) Bacteria invade Schwann cells. Granuloma is formed due to good immune response. Since myelin sheath is tough and cannot expand, nerve is compressed. Nerve compression leads to loss of hair, loss of sweating and anaesthesia Presence of granuloma in biopsy. Smear is negative for bacilli Lepromin test highly positiveBORDERLINE TUBERCULOID (BT) Borders ill defined Satellite lesions (1 to 10) around the main lesions. Smear is negative, lepromin test positive.LEPROMATOUS LEPROSY (LL) No immunity: lepromin test negative, smear is laden with macrophages filled with lepra bacilli. (Grenzone) Many lesions all over the body. Bilateral, symmetrical lesions. Blood stream dissemination. Hair loss, sweating loss not present as sympathetic nerves are not involved. Well formed, symmetrical nodules. Glove and stocking pattern of anaesthesia (fibrosis of lesions containing bacilli laden macrophages)BORDERLINE BORDERLINE (BB) Annular or punched out lesions Features can be of either end of the disease Smear is positive, lepromin negative.BORDERLINE LEPROMATOUS (BL) Not so symmetrical as in LL. Smear negative in areas other than lesions. Grenzone is not well determined. Keshava Pavan
SKIN & VD 4-2-2013II. INDIAN CLASSIFICATIONNEURITIC TYPE Nerve abscesses seen Can be mono- or poly-neuriticINDETERMINATE TYPE Vague, hypopigmented patches. Beginning stage of the disease. Can progress to either sides of the spectrum. *** Keshava Pavan