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CORRESPONDENCE
Year : 2016  |  Volume : 61  |  Issue : 1  |  Page : 100-102
Saucer lesions in leprosy: Anatomy of the controversy


Department of Dermatology, Venereology and Leprosy, Dr. P.N. Behl Skin Institute, School of Dermatology, New Delhi, India

Date of Web Publication15-Jan-2016

Correspondence Address:
Sarvesh Sunil Thatte
Department of Dermatology, Venereology and Leprosy, Dr. P.N. Behl Skin Institute, School of Dermatology, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.174050

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How to cite this article:
Bhushan P, Thatte SS. Saucer lesions in leprosy: Anatomy of the controversy. Indian J Dermatol 2016;61:100-2

How to cite this URL:
Bhushan P, Thatte SS. Saucer lesions in leprosy: Anatomy of the controversy. Indian J Dermatol [serial online] 2016 [cited 2019 Jul 20];61:100-2. Available from: http://www.e-ijd.org/text.asp?2016/61/1/100/174050


Sir,

The "saucer" morphologies have been used in leprosy to describe certain types of lesions. Unfortunately, different text books and publications give different opinions. Let us examine the anatomy of this controversy surrounding the enigma of saucers in leprosy.

It is well accepted that tuberculoid leprosy (TT) plaques can be either homogenously elevated or gradually flatten in the center (representing central healing and peripheral spread). [1],[2],[3],[4] For this morphology of "a plaque with a sharply defined and elevated border that slopes down to a flattened atrophic center," term "Saucer right way up" has been used." [5] "Inverted saucer" term was first suggested by Molesworth for lesions in borderline (dimorphous) leprosy with vague edges and infiltration intensifying from the periphery to the center. [6],[7] The view is shared by other authors. [4],[8],[9] On the other hand, other authors have used the term to describe annular lesions with sharp central punch and sloping outer borders. [10],[11] However, this seems identical to a "punched out" or "Swiss-cheese" lesion, which has been defined as having an ill-defined, sloping outer margin and a "punched-out" center with a very well demarcated inner edge. [1],[2],[4],[12] Indeed, some authors have used both terms as synonyms. [3] In light of the previous discussion, we suggest the following morphological definitions be used consistently [Figure 1]:
Figure 1: Morphological definitions of lesions in leprosy as suggested in the article

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  • Saucer right way (side) up lesion: Annular lesion with a sharp outer edge and vague inner edge that slopes towards the center of the lesion
  • Punched-out (Swiss-cheese) lesion: Annular lesion with sharp central punch with clear inner but vague and sloping outer edges
  • Annular lesions: Annular lesions with both inner and outer edges being sharp and clear cut [2]
  • Inverted saucer lesion: A dome-shaped lesion with central infiltration and gradual peripheral sloping.


We now discuss where these lesions are seen in the spectrum of leprosy. There is near uniformity in the literature that saucer right way up lesion is seen in TT leprosy. [1],[2],[5],[12],[13] Similarly, it is widely agreed that infiltrated lesions of borderline lepromatous (BL) leprosy are centrally elevated and gradually slope towards the periphery. [1],[4],[9],[12],[13] Thus, it is clear that inverted saucer lesions are seen in BL leprosy. Punched-out lesions or Swiss-cheese lesions are characteristic of borderline borderline (BB) leprosy. [1],[4],[9],[12],[13] Of course, if we follow the Indian classification it would be correct to say that borderline leprosy can have both punched-out as well as the inverted saucer lesions. [2],[4] Annular lesions with sharp inner and outer borders are also typical of borderline leprosy [2] most likely in BB. Ideally, features of a lesion should be described without the use of analogies, such as "saucer-like." However, since these are used and often asked, we have tried to put to rest the confusions regarding the saucer lesions in leprosy and corrective steps would be undertaken by various authors in future, to make the life of students a little easier.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Pfaltzgraff RE, Ramu G. Clinical leprosy. In: Hastings RC, editor. Leprosy. 2 nd ed. Edinburgh: Churchil Livingstone; 1994. p. 237-87.  Back to cited text no. 1
    
2.
Jopling WH, McDougall AC, editors. The disease. In: Handbook of Leprosy. 5 th ed. New Delhi: CBS Publishers and Distributors; 1996. p. 10-53.  Back to cited text no. 2
    
3.
Palit A, Ragunatha S, lnamadar AC. History taking and clinical examination. In: Kar HK, Kumar B, editors. IAL Textbook of Leprosy. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2010. p. 121-43.  Back to cited text no. 3
    
4.
Yawalkar SJ. Leprosy for Medical Practitioners and Paramedical Workers. 8 th ed. Basle: Novartis Foundation for Sustainable Development; 2009.  Back to cited text no. 4
    
5.
James WD, Berger TG, Elston DM, editors. Hansen's disease. In: Andrews' Diseases of the Skin. 11 th ed. London: Saunders Elsevier; 2011. p. 333-44.  Back to cited text no. 5
    
6.
Cochrane RG. Signs and symptoms. In: Cochrane RG, Davey TF, editor. Leprosy in Theory and Practice. Bristol: John Wright and Sons; 1964. p. 251-79.  Back to cited text no. 6
    
7.
Cochrane RG. The spectral concept of leprosy. Ann Soc Belges Med Trop Parasitol Mycol 1964;44:71-6.  Back to cited text no. 7
    
8.
McDougall AC, Yuasa Y. A New Atlas of Leprosy. Tokyo: Sasakawa Memorial Health Foundation; 2002.  Back to cited text no. 8
    
9.
Garg VK, Sardana K. Comprehensive textbook of dermatology. New Delhi: Peepee Publishers; 2010. p. 30-80.  Back to cited text no. 9
    
10.
Khanna N. Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases. 4 th ed. Delhi: Elsevier; 2011. p. 241-98.  Back to cited text no. 10
    
11.
Kar HK. Hansen's disease. In: Vishwanath V, editor. IADVL's Concise Textbook of Dermatology. Delhi: Wiley-Blackwell; 2012. p. 91-113.  Back to cited text no. 11
    
12.
Sharma VK, Malhotra AK. Leprosy: Classification and clinical aspects. In: Valia RG, Valia AR, editors. IADVL's Textbook of Dermatology. Mumbai: Bhalani Publishing House; 2010. p. 2032-69.  Back to cited text no. 12
    
13.
Kumar B, Dogra S. Case definition and clinical types. In: Kar HK, Kumar B, editors. IAL Textbook of Leprosy. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2010. p. 152-66.  Back to cited text no. 13
    


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