title: A retrospective analysis of histopathology of 64 cases of lepra reactions.
abstract: BACKGROUND
  Lepra reactions are not always diagnosable under the microscope. We analyzed skin histopathology in 64 cases of lepra reaction.
  
  
  OBJECTIVE
  To make detailed observations on histopathologic features of type 1 and type 2 lepra reaction (erythema nodosum leprosum, ENL).
  
  
  METHODS
  In this retrospective study, we included 64 patients diagnosed during a 3-year period as lepra reaction based on clinico-pathological co-relation.
  
  
  RESULTS
  Out of the 64 patients, 22 were of type 1 reaction and 42 of ENL. The most consistent finding in type 1 reaction was papillary dermal edema (86%) followed by pyknosis of lymphocytes (77%) and intercellular edema within granuloma (73%). Surprisingly, folliculotropism of lymphocytes was seen in 55% and subcutaneous infiltration in 36%. In ENL, the most common finding was presence of neutrophils within the granuloma (100%), followed by leukocytoclasia (81%), papillary dermal edema (81%), and neutrophilic panniculitis (69%). Fibrin in the vessel wall or/and granulomas was noted in only 38% while fibrin thrombi in the vessel walls were seen in only 12% of 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 were frequent in type 1 reactions while neutrophilic panniculitis was common with ENL.
authors.affiliation: Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Adhe
authors.forename: Atul
authors.initials: A
authors.lastname: Dongre
authors.forename: Uday
authors.initials: U
authors.lastname: Khopkar