title: Degree of skin denervation and its correlation to objective thermal sensory test in leprosy patients.
abstract: BACKGROUND
  Leprosy is an infectious disease affecting skin and peripheral nerves resulting in increased morbidity and physical deformities. Early diagnosis provides opportune treatment and reduces its complications, relying fundamentally on the demonstration of impaired sensation in suggestive cutaneous lesions. The loss of tactile sensitivity in the lesions is preceded by the loss of thermal sensitivity, stressing the importance of the thermal test in the suspicious lesions approach. The gold-standard method for the assessment of thermal sensitivity is the quantitative sensory test (QST). Morphological study may be an alternative approach to access the thin nerve fibers responsible for thermal sensitivity transduction. The few studies reported in leprosy patients pointed out a rarefaction of thin dermo-epidermal fibers in lesions, but used semi-quantitative evaluation methods.
  
  
  RESULTS
  This work aimed to study the correlation between the degree of thermal sensitivity impairment measured by QST and the degree of denervation in leprosy skin lesions, evaluated by immunohistochemistry anti-PGP 9.5 and morphometry. Twenty-two patients were included. There were significant differences in skin thermal thresholds among lesions and contralateral skin (cold, warm, cold induced pain and heat induced pain). The mean reduction in the density of intraepidermal and subepidermal fibers in lesions was 79.5% (SD = 19.6) and 80.8% (SD = 24.9), respectively.
  
  
  CONCLUSIONS
  We observed a good correlation between intraepidermal and subepidermal fibers deficit, but no correlation between these variables and those accounting for the degree of impairment in thermal thresholds, since the thin fibers rarefaction was homogeneously intense in all patients, regardless of the degree of sensory deficit. We believe that the homogeneously intense denervation in leprosy lesions should be objective of further investigations focused on its diagnostic applicability, particularly in selected cases with only discrete sensory impairment, patients unable to perform the sensory test and especially those with nonspecific histopathological finds.
authors.affiliation: Departamento de Patologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Ismael Alves
authors.initials: IA
authors.lastname: Rodrigues Júnior
authors.forename: Isabel Cristina Costa
authors.initials: IC
authors.lastname: Silva
authors.forename: Letícia Trivellato
authors.initials: LT
authors.lastname: Gresta
authors.forename: Sandra
authors.initials: S
authors.lastname: Lyon
authors.forename: Manoel de Figueiredo
authors.initials: Mde F
authors.lastname: Villarroel
authors.forename: Rosa Maria Esteves
authors.initials: RM
authors.lastname: Arantes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007918:Leprosy / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology* / Q000502:physiology*; D009460:Neurologic Examination / Q000379:methods; D012684:Sensory Thresholds; D012867:Skin / Q000473:pathology* / Q000503:physiopathology*; D013697:Thermosensing; D055815:Young Adult