Clinical and histopathological features of paucibacillary leprosy before and after multidrug therapy: a prospective study.
Leprosy often heals with residual skin lesions after completion of treatment. WHO recommends fixed duration multidrug therapy (MDT) irrespective of whether lesions clear or persist after treatment. Patients with residual lesions are often unsatisfied and may undergo repeat biopsy and re-treatment. This study was conducted to compare the clinicohistopathological features in paucibacillary leprosy before and after MDT from September 2012 to February 2014.



Sixty-one untreated cases of paucibacillary leprosy were investigated and given standard WHO paucibacillary-MDT for 6 months. Scoring of clinical activity was done; histopathological activity was graded according to granuloma fraction. Forty-four patients who completed the treatment were subjected to post-treatment biopsy. Clinical response to therapy was graded as active, resolving and inactive and histopathological changes were compared in all patients.



Among the 44 patients, the lesions were inactive, resolving and active in 39% (17/44), 39% (17/44) and 23% (10/44) of patients respectively. Histologically, disease was inactive, resolving and active in 30% (13/44), 9% (4/44) and 61% (27/44). But histomorphological features suggesting regression: loose granulomas (59%, 26/44); lymphocyte predominance (66%, 29/44); vacuolar change in epithelioid cell cytoplasm (59%, 26/44), were statistically significant in post-treatment compared to pre-treatment.



Although histological resolution is slower than clinical resolution, qualitative histomorphological changes in correlation with clinical inactivity can offer a fair suggestion to the clinician to terminate therapy.
Department of Dermatology, VMMC & Safdarjung Hospital, New Delhi-110029, India Sourabh.kem@gmail.com.
Sourabh
S
Jain
Department of Dermatology, VMMC & Safdarjung Hospital, New Delhi-110029, India.
V
V
Ramesh
Department of Pathology, National Institute of Pathology, ICMR, Safdargjung Campus, New Delhi-110029, India.
Avninder
A
Singh
Department of Pathology, VMMC & Safdarjung Hospital, New Delhi-110029, India.
Amit
A
Yadav
Department of Dermatology, All India Institute of Medical Sciences, New Delhi-110029, India.
M
M
Ramam
Department of Dermatology, All India Institute of Medical Sciences, New Delhi-110029, India.
Sujay
S
Khandpur
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D004359:Drug Therapy, Combination; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000209:etiology; D006801:Humans; D056005:Leprosy, Paucibacillary / Q000188:drug therapy / Q000473:pathology*; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012867:Skin / Q000473:pathology*; D014944:World Health Organization
Histopathological changes; Leprosy; Leprosy regression; Paucibacillary leprosy; Response to multidrug therapy; Treated leprosy