Clinical Features Character and prognosis Skin lesions Nerve damageBacte, diascopy Histology Leprornalous TypeStable, malign, and progressive Lepromas, papular or nodular low and symmetrical Abundant bacilliXanthoma-like borderline GroupUnstable, either progressive or regressive Plaques, often annular. generally more rapid than in lepromatous; symmetrical Many bacilliSazcoid-like but with some lipid-filled cells: Indeterminate Group Tuberculoid Type Unstable, often regrettable, benign, usually receive may progress to aggressive either “polar” typePale or pink macules Pale macules or raised plaques, often annular Usually only slight and Sudden. severe asymmetry symmetrical ricalFew bacilli, if any Usually no bacilli except during reactions, and in nervesBanal round-cell infiltra-Sarcoid-like tion Lepromin reaction Negative “diascopy Histology Leprornalous“Negative or weakly positive Negative or weakly postpositive, often strongly so Rica Except in Lucio’s “pure diffuse” lepromatous leprosy, in which no lepromas occur. This form is rare outside of Mexico and Costafinally are known as “maculoanesthetic.” Wade believes that it should still be so designated, on the ground that patients with such flat lesions have not developed enough resistance to warrant being classified as tuberculoid.
A benign form, relatively unstable, seldom bacteriologically positive, presenting flat skin lesions via may be hypopigmented or erythematosus the reaction to lepromin negative or positive gate manifestations, more or less extensive, may develop in some cases which have persisted as of this group for long periods. The indeterminate group consists essentially of “simple macular” cases. These cases may evolve toward the lepromatous type or the tuberculoid type or may remain sinenangp&Whefinitely.
Borderline (dimorphous) group (B).’ A malign loan, ‘,1.C•3 unstable, almost always strongly positive on bacteriologic examination, with the lepromin reaction generally negative. This group may arise from the tuberculoid type as a result of repeated reactions and sometimes evolves to the lepromatous type. The nasal mucosa is generally negative for acid-fast bacilli. The skin lesions are usually seen as plaques, bands, nodules, etc., with a regional distribution similar to that of lepromatous leprosy, except for [usually but not always] conspicuous asymmetry. The ear lobes are likely to present the appearance of lepromatous infiltrate.
Clinical Features lesions frequently have a soft or succulent appearance and their periphery slopes away from the center table types AND GROUPS OF LEPROSY, WITH SUBTYPES AND SYMBOLS, AS APPROVED BY THE SIXTH INTERNATIONAL CONGRESS OF LEPROSY AT MADRID IN 1953, AND REAFFIRMED
•TOKYO IN 1963
Lepromatous Indeterminate (I)
Pure neuritic (?)
Tuberculoid (r) Borderline (dimorphous) (B)
Minor tuberculoid (1′,) Macular (?)*
Major tuberculoid Pure neuritic ?)
*The bracketed question marks, inserted by the Classification Committee of the Congress, indicate that the queried categories have not yet been described in the literature.