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Tuberculoid Leprosy : Clinical Features

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Tuberculoid leprosy is seen in patients with strong cell-mediated immunity and low antibody titers to Mycobacterium leprae. The skin lesions consist of asymmetrical, hypopigmented, anesthetic and anhidrotic patches on face, limbs, or trunk. Some lesions appear as erythematous plaques with raised margins and a flat hypopigmented center.

Superficial nerves in the vicinity of the skin lesions may be thickened and tender. Nerve involvement is an early feature of tuberculoid leprosy and is often accompanied by muscle wasting and weakness in the area supplied by the involved nerve. The wasting of interosseous, thenar and hypothenar muscles can cause flexion contracture of fingers resulting in claw hand. Sensory loss due to nerve damage can result in foot drop, neuropathic ulceration and traumatic amputation of toes and fingers.

The image shows a large hypopigmented, anesthetic skin patch on the back of a 35 y/o female with tuberculoid leprosy. Image courtesy of: Dr. Ian McColl; Global Skin Atlas; Used with permission.

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