LEPROSY TYPE MULTIBASILER WITH XEROSIS CUTIS

Abstract

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae, affects the skin
and peripheral nervous system. According to the WHO classification, leprosy is divided into two,
Pausi Basiler and Multi Basiler. One skin disorder that is often experienced by patients with
leprosy is xerosis cutis. Xerosis cutis is characterized by a dull skin tone, rough texture, and the
increase in the number of wrinkles due to lack or loss of moisture contents of the stratum
corneum.

Case: Woman, 18 years, presented with thick scaly skin on the hands and feet since 6 months.
Initially the skin felt dry and rough then appeared scales were becoming increasingly bold.
Patients did not received leprosy treatment. Contact history with leprosy patients was not found.
On dermatological examination found xerosis cutis in antebrachii dextra et sinistra and cruris
dextra et sinistra regions. Also found madarosis, saddle-nose and digities III-V manus dextra
absorption, digities I, V manus sinistra absorption, aurikular dextra et sinistra infiltrates.
Examination of skin scrapings carried out on the right and left ear lobes, found M. leprae with
bacteriological index +5. Management of these patients was a MDT-MB regimen and education
about skin care legs and hands with emollient.

Discussion: The diagnosis of multibasiler leprosy was upheld by history, physical examination,
and examination of skin scrapings. Xerosis cutis is a disorder that occurs in leprosy patients due
to autonomic nerve dysfunction. Xerosis is caused by damages to the sweat glands and changes
in the lipid composition of the stratum corneum which causes skin protection malfunctioning.
Emollient is essential in the treatment of dry skin in leprosy.

Keywords: Leprosy, Xerosis cutis

LEPROSY TYPE MULTIBASILER WITH XEROSIS CUTIS

Background
A chronic granulomatous disease caused by Mycobacterium leprae, principally affecting
peripheral nerves and skin.1,2 According to the WHO classification, leprosy is divided into two,
Pausi Basiler and Multi Basiler. 1

Demonstration of acid-fast bacilli (AFB) in skin smear examination serves several purposes:3
1. To confirm the diagnosis of leprosy
2. To classify the disease
3. To determine the infectivity of a patient
4. To assess the progress of the disease
5. To follow up the patients on treatment.

Treatment for leprosy :1

Leprosy involves both the skin and peripheral nervous system. Leprosy patients display
an increased incidence of xerosis and altered sensory thresholds, which persist in previously
active skin sites.2 Xerosis or dry skin describes skin that is characterized by dull color (usually
gray white), rough texture, and an elevated number of ridges. The etiology of this common
condition is multifactorial. The most significant factor in the development of xerosis is the role
of the stratum corneum (SC) and its capacity to maintain skin hydration. Rawlings et al showed
that patients with dry skin have a perturbation in the lipid bilayer of the SC, which is associated
with increased fatty acid and decreased ceramide levels. Defects or deficiencies in this barrier
layer of the skin cause a spike in water evaporation, known as transepidermal water loss
(TEWL).4 The stratum corneum (SC) is the surface layer of the skin, composed of corneocyte
cells and intercellular lipids, complex composition organized in liquid crystalline structures. SC
protects the skin from drainage and gives it softness and flexibility. SC hydration state affects the
barrier function of the skin, the penetration of active substances and skin mechanical properties.
The increase in skin hydration leads to the swelling of the SC and softening of its structure.
When the moisture content of the skin drops below a certain level, the liquid crystalline
structures, present in the SC lipids organization, are destroyed and skin becomes dry.5

Case

Woman, 18 years, presented with thick scaly skin on the hands and feet since 6 months.
Initially the skin felt dry and rough then appeared scales were becoming increasingly bold.
Patients did not received leprosy treatment. Contact history with leprosy patients was not found.

In physical examination showed a normal general condition and normal vital signs. In
dermatological examination found xerosis cutis in antebrachii dextra et sinistra and cruris dextra
et sinistra regions. Also found madarosis, saddle-nose and digities III-V manus dextra
absorption, digities I, V manus sinistra absorption, aurikular dextra et sinistra infiltrates.(figure
1)

Examination of skin scrapings carried out on the right and left ear lobes, found M. leprae
with bacteriological index +5.
 Figure 1

The patient was diagnosed with Morbus hansen type multibasiler with xerosis cutis.
Management of these patients was a MDT-MB regimen and education about skin care legs and
hands with emollient.

On follow up after 2 weeks treatment, Dry skin already looks less. The treatment was
continuous. (figure 2)
Figure 2
 The prognosis of the patient was quo ad vitam bonam, quo ad functionam bonam, quo ad
sanationam dubia ad bonam

Discussion
The diagnosis of multibasiler leprosy was upheld by history, physical examination, and
examination of skin scrapings.
Emollients are the cornerstone of the treatment of dry skin conditions6 and are typically
delivered in over-thecounter (OTC) moisturizers.6 Emolient are substances added to cosmetics to
soften and smooth the skin. They function by filling the spaces between desquamating
corneocytes to create a smooth surface. Emollients provide increased cohesion causing a
flattening of the curled edges of the individual corneocytes. This leads to a smoother surface with
less friction and greater light refraction. Many emollients function as humectants and occlusive
moisturizers as well. Lanolin, mineral oil, and petrolatum are examples of occlusive ingredients
that also confer an emollient effect.4

Emollients are delivered in the form of creams, ointments, gels, pastes, or liquid
preparations. They increase the moisture content of the SC by providing an occlusive oily film on
the skin surface to reduce transepidermal water loss (TEWL), which is the normal movement of
water through the SC, and by serving as humectants, that is, binding water and thus increasing
the water holding capacity in the SC.7 Emollients thus prevent and alleviate skin dryness by
increasing skin hydration and reducing TEWL and promote recovery of the damaged skin
barrier, including that observed in atopic skin.7,8

Emollient creams are often used to alleviate the objective and subjective characteristics of
dry skin. They contain emollient ingredients that enhance skin hydration and plasticity showing
twofold action: occlusive effect - covering the skin surface by reducing water loss from the SC,
and tying water from the atmosphere (moisturizing effect). The chemical structure and polarity
of emollients, as common ingredients of the moisturizing creams, may affect the structure of the
o/w cream, its sensory characteristics, aesthetic features and mechanism of interaction with skin.5
 REFERENCE

1. Lockwood D.N.J : Leprosy, edited by Tony B.Stephen B.Neil C.Christopher G, in Rook’s

Textbook of Dermatology ; Eighth edition.Wiley-Blackwell.2010; 32.1

2. Song SP, Ferngold KR, Hou QN.Abnormalities in Stratum Corneum Function in Patients
Recovered from Leprosy.USA.2008; 22:131–136

3. Mishra RS, Kumar J: Classification, edited by Hementa Kumark, Bhushan Kumar, in IAL
Text Book of Leprosy, Jatpee Brothers Medical Publishers : New Delhi,2010 P 144-

4. Lee DJ, Rea TH, Modlin RL : Leprosy, edited by Wolff K, Goldsmith LA, Katz SI,
Gilchrest BA, Paller AS, Leffell DJ. In Fitzpatrick’s Dermatology in General Medicine.
8th Edition. New York: McGraw Hill,2012 P 2253-62

5. Stojiljković D, Arsić I, Kostov MT, Jovanović Z,Tadić V, Đorđević S. Investigation of

the Effects of DifferentEmollients on the Structure and SkinMoisturizing Potential of the
CosmeticCreams. Scientific Journal of the Faculty of Medicine in Niš.2013; 30 (4):193-
200

6. Fowler J. Understanding the Role of NaturalMoisturizing Factorin Skin Hydration

Practical Dermatolog. 2012: 36-40

7. Roure R, LanctinM, Nollent V, Bertin C. Clinical Study Methods to Assess the

Protective Efficacy of Emollients againstClimatic and Chemical AggressorsDermatology
Research and Practice. 2012; 1-5

8. White-Chu EF, Reddy M. Dry skin in the elderly: Complexities of a common problem. Clinics in
Dermatology.2011; 29: 37–42