1. Semin Cutan Med Surg. 2007 Jun;26(2):126-30. doi: 10.1016/j.sder.2007.02.010.

Erythema nodosum leprosum: reactional leprosy.

Cuevas J(1), Rodríguez-Peralto JL, Carrillo R, Contreras F.

Author information:
(1)Department of Pathology, Hospital General Universitario, Guadalajara, Spain.
jcuevas@sescam.org

The different clinical forms of leprosy are mainly related to the variety of
immunological responses to the infection. Thus, lepromatous leprosy occurs in
patients with a poor cell-mediated immunity to Mycobacterium leprae, whereas
tuberculoid leprosy is associated with a high resistance to leprosy bacillus.
Intermediate forms, including borderline tuberculoid leprosy, borderline
lepromatous leprosy, and borderline leprosy, are a continuous and unstable
spectrum of the disease. Leprosy reactions are rare and not well-known states
that interrupt the usual chronic course and clinical stability of patients with
leprosy. They are expressions of immunological perturbations. Attending to the
clinical and histopathological manifestations, leprosy reactions may be
separated in 2 or 3 different variants: reverse reaction (type I), erythema
nodosum leprosum (type II), erythema polymorphous (type II) and Lucio's
phenomenon, mainly considered a type II reaction, but sometimes designated type
III. Type I leprosy reaction, also named "upgrading reaction," occurs in
borderline leprosy states and is associated with a shift toward the tuberculoid
pole. Type II reaction usually occurs in lepromatous leprosy, and there are 3
different clinical variants, including erythema nudosum leprosum, erythema
polymorphous-like reaction, and Lucio's phenomenon.

DOI: 10.1016/j.sder.2007.02.010
PMID: 17544965 [Indexed for MEDLINE]