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CORRESPONDENCE
Year : 2018  |  Volume : 63  |  Issue : 4  |  Page : 354
Clinical and histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 months: A prospective observational study from Eastern India - A comment


Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat, India

Date of Web Publication9-Jul-2018

Correspondence Address:
Dr. Pragya Ashok Nair
Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_115_18

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How to cite this article:
Nair PA, Pariath K. Clinical and histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 months: A prospective observational study from Eastern India - A comment. Indian J Dermatol 2018;63:354

How to cite this URL:
Nair PA, Pariath K. Clinical and histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 months: A prospective observational study from Eastern India - A comment. Indian J Dermatol [serial online] 2018 [cited 2020 Jul 7];63:354. Available from: http://www.e-ijd.org/text.asp?2018/63/4/354/236214




Sir,

We read with great interest the article, “Clinical and Histopathological Response to Multidrug Therapy in Paucibacillary Leprosy at the end of 6 Months: A Prospective Observational Study from Eastern India” which appeared in the Indian Journal of Dermatology, Issue 1, Volume 63, January–February 2018.[1]

The authors stated that relatively high proportion (14%) of the lesions were in Type 1 reaction (T1R) at the time of diagnosis in this study. However, in the clinical scoring system, they had not considered T1R or Type 2 reaction (T2R) as a measure of clinical scoring, especially since they mentioned that borderline tuberculoid was the most common type of paucibacillary (PB) leprosy present in the study. Borderline leprosy cases are immunologically unstable with frequent changes in cell-mediated immunity even in untreated cases (as previously untreated cases were considered in this study). Moreover, histological correlates that are suggestive of T1R include dermal edema, intercellular edema in granulomas, necrosis in the center of granuloma, apoptosis of lymphocytes, and presence of multiple, large giant cells.[2] Upgrading reactions seen after beginning multidrug therapy (MDT) are characterized by the influx of lymphocytes and development of large giant cells with dermal and intercellular edema whereas downgrading of immunity toward the lepromatous pole results in change in morphology of histiocytes from epithelioid to histiocytic macrophages with foamy and vacuolated cytoplasm.[3] These histopathological features have not been considered separately in the study.

Histopathological features of reaction may even be seen in patients who have no clinical signs of the same, duly explained by the time lag between immunological shifts and the corresponding clinicohistopathological findings. Clinical changes occur much later than the tissue changes that are reflected in the histopathology.[3]

Hence, we suggest that the clinical scoring as well as the histopathological assessment done in the study should preferably have included T1R and T2R to correctly assess the efficacy of treatment post-MDT-PB regimen.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Podder I, Saha A, Bandyopadhyay D. Clinical and histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 months: A prospective observational study from Eastern India. Indian J Dermatol 2018;63:47-52.  Back to cited text no. 1
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2.
Lockwood DN, Lucas SB, Desikan KV, Ebenezer G, Suneetha S, Nicholls P, et al. The histological diagnosis of leprosy type 1 reactions: Identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol 2008;61:595-600.  Back to cited text no. 2
    
3.
Joshi R. Limitations of histopathology in diagnosis and management of patients with leprosy. Indian J Dermatol Venereol Leprol 2014;80:389-91.  Back to cited text no. 3
[PUBMED]  [Full text]  




 

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