Tuberculoid Leprosy

A 47-year-old woman from Southeast Asia presented with erythematous, asymmetric, anesthetic, sharply marginated plaques on her lower arms and hands. Because this patient had emigrated from a tropical climate, leprosy was suspected. A skin biopsy revealed dermal epithelioid granulomas with a peripheral lymphocytic cuff. A Fite method stain was done and yielded few mycobacteria. The results of a lepromin test were positive, confirming a diagnosis of the tuberculoid form of leprosy.

Leprosy is endemic to an equatorial band comprising Africa, Southeast Asia, and South America. The disease can also be found in Hawaii, Louisiana, and Texas and other areas of the United States with large immigrant populations, such as California and Florida. The least infectious form of this Mycobacterium leprae–caused disease, tuberculoid leprosy is considered to be relatively benign but may destroy peripheral nerves and lead to focal paralysis.

Drs Charles E. Crutchfield III and Eric J. Lewis of Minneapolis write that a 5-year course of antituberculoid leprosy therapy (dapsone, 100 mg/d) was initiated shortly after this photograph was taken.