Classification of leprosy

1. SKIN & VD 4-2-2013
Keshava Pavan
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.

2. SKIN & VD 4-2-2013
Keshava Pavan
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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