Clinical and histopathological features in lepra reaction: a study of 50 cases


  • Urvi H. Shah Department of D.V.L., P.D.U Government Medical College and Hospital, Rajkot, Gujarat
  • Monal M. Jadwani Department of D.V.L., P.D.U Government Medical College and Hospital, Rajkot, Gujarat
  • Sahana P. Raju Department of D.V.L., P.D.U Government Medical College and Hospital, Rajkot, Gujarat
  • Pranav H. Ladani Department of D.V.L., P.D.U Government Medical College and Hospital, Rajkot, Gujarat
  • Neela V. Bhuptani Department of D.V.L., P.D.U Government Medical College and Hospital, Rajkot, Gujarat



Erythema nodosum leprosum, Lepra reaction, Type 1 reaction


Background: Lepra reactions remain a major persistent problem in leprosy. Type 1 and type 2 (erythema nodosum leprosum-ENL) reactions are the major causes of nerve damage and permanent disabilities. Diagnosing lepra reactions correctly is important for timely institution of therapy to prevent and treat disability and morbidity. Aim and objectives of the study were to make detailed observations on clinical and histopathological features of type1 and type 2 lepra reactions.

Methods: In this study we included 50 patients diagnosed during a 1-year period as lepra reactions based on clinic-histopathological corelation.

Results: Out of the 50 patients, 4 were of type 1 reaction and 46 of type 2 reaction from which recurrence was more commonly seen with type 2 reactions. The most consistent histopathological findings in type1 reaction were periadnexal inflammatory infiltrates (100%) and lymphocytes in granuloma (100%), followed by papillary dermal edema and intercellular edema within granuloma (75%). Surprisingly, folliculotropism of and lymphocytic panniculitis was seen in 50% cases. In ENL, the most common histological findings were periadnexal inflammatory infiltrates (95.6%), presence of neutrophils within the granuloma (86.9%), foamy macrophages followed by papillary dermal edema (69.5%), and neutrophilic panniculitis (43.4%). Vasculitis like changes was noted in only 46% cases.

Conclusions: Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis are frequent in type1 reactions while neutrophilic panniculitis is common with ENL.

Author Biography

Urvi H. Shah, Department of D.V.L., P.D.U Government Medical College and Hospital, Rajkot, Gujarat

Second year resident in dermatology, venereology and leprosy


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