Journal Reading

Morbus Hansen Subdivision

Leproma’s Dermoscopy
Anna Carolina Miola, Helio Amante Miot, Natalia Parenti Bicudo,
Giuliane Minami Tsutsui

Read By :
dr. Sheila Hustadi Budiawan

Supervised By :
Dr. dr. Anni Adriani, Sp. KK (K), FINSDV, FAADV

Dermatology and Venereology Department

Hasanuddin University Faculty of Medicine
Makassar
2021
INTRODUCTION
The prevalence of leprosy has been declining as a result of multi
drug therapy.

Brazil  endemic area. Delayed diagnosis, especially in

multibacillary forms, is one of the main factors in the spread of
the disease.

Characteristically, leprosy evolves in a chronic, indolent form,

polymorphous lesions and in an oligosymptomatic form.

Virchowian forms are even more indolent  diffuse infiltration. Make

diagnosis more difficult.
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INTRODUCTION
Lepromas even though
asymptomatic  often the
reason for seeking medical
care.
As Virchowians are the
most bacilliferous, all
strategies for identification
and early treatments are
valuable.
Generate diagnostic
confusion with other
papulonodular dermatoses
such as granuloma
annulare, dermatofibroma
and sarcoidosis.
The dermoscopic findings
of the lepromas are
described.
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CASE PRESENTATION
Male, 54 years old,
brown-skinned,
with asymptomatic nodular
lesions throughout his skin
since one year ago

Multiple normochromic
papules with fibromatous
consistency
Diffuse infiltration of the
skin and diffuse loss of
hair on the body

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Case
Presentation

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Case
Presentation

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Case
Presentation

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 CASE PRESENTATION

Was treated for leprosy ± Pathological examination:

Patient reported 20 years ago, and unsure
family similar diffuse infiltration of
of the schedule or xanthomatous macrophages 
cases treatment time used at observed in the superficial and
that time deep dermis

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CASE PRESENTATION
Fite-Faraco staining
revealed multiple
globules of viable
bacilli within these
macrophages.

Earlobe and leproma

baciloscopy resulted
in a bacilloscopic
index of 6+ with
innumerable intact
bacilli

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 Individuals with virchowian pole present humoral
immune response, with high production of
antibodies against the PGL-1 antigen,

These antibodies are ineffective in the elimination

of M. leprae, with consequent multiplication and DISCUSSION
bacillary spread through the haematogenic pathway

Skin lesions tend to be multiple and symmetrical, localized,

poorly delimited, associated or not with generalized
cutaneous infiltration, which can progress to infiltrated
papules, plaques and nodules, called lepromas (few or
large number)
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 Currently used in
Dermoscopy had the detection and
a great diagnosis of other
importance in the non-tumoral skin
diagnosis of diseases, such as DISCUSSION
cutaneous inflammatory and
tumors. infectious
dermatoses.

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DISCUSSION

The dermoscopic description

of the lesions of some clinical To date, there are no
forms (histoid and descriptions of the
tuberculoid) of leprosy can be dermoscopic features of
found in the literature. lepromas.

Dermoscopic appearance is Histoid form presents multiple

similar to histoid form  fine fusiform histiocytes grouped in
telangiectasias associated with strip, different from the
a halo of brownish xanthomatous macrophages
pigmentation. commonly found in lepromas

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 Yellowing color  the intense xanthomization of the
lepromes (Virchow cells), which is less evident in other
lesions such as granuloma annular, sarcoidosis and
xanthogranuloma, which show orange color due to the
fusiform appearance of the macrophages that form them.

DISCUSSION

Peripheral brownish pigmentation of the lesion in

dermoscopy may be more difficult to observe in patients
with a higher phototype.

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In pathological examination of
the leproma  accumulation
of macrophages grouped in
the superficial and deep
dermis, with clear cytoplasm
and vacuolated aspect.
These vacuoles, in the
coloration of fite-Faraco,
contain a large quantity of
bacilli; forming globes.
DISCUSSION

Vascular dilatation in the superficial

dermis may also be visualized.

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 On dermoscopic
observations, the correlation
of the visualized structures
with the alterations in the
examination can be
performed.
The presence of numerous
macrophages containing
globules with the nodular
appearance of the lesion and
the vascular dilatation (thin
telangiectasias)

DISCUSSION

Such dermoscopic features make a differential

diagnosis with other dermatoses

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 Treatment with the diagnosis
The diagnosis of leprosy,
should be done promptly, as
however, is clinical, the
well as investigation of
dermatoscopic aspects, as
communicators, in order to
well as laboratory tests, DISCUSSION
reduce the transmission of the
anatomopathological and
bacillus and controlling the
specific staining help in cases
incidence of new cases of the
of greater clinical difficulty.
disease in the country.

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THANK YOU