1. SKIN & VD 4-2-2013
CLASSIFICATION OF LEPROSY
I. RIDLEY AND JOPLING’S CLINICAL CLASSIFICATION OF LEPROSY
TUBERCULOID 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 positive
BORDERLINE 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
2. SKIN & VD 4-2-2013
II. INDIAN CLASSIFICATION
NEURITIC TYPE
Nerve abscesses seen
Can be mono- or poly-neuritic
INDETERMINATE TYPE
Vague, hypopigmented patches.
Beginning stage of the disease.
Can progress to either sides of the spectrum.
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Keshava Pavan