Dermoscopic, clinical, and histopathological aspects of leprosy and lepra reaction cases: An observational cross-sectional study

Context: Owing to myriad clinical presentations in leprosy, it becomes a diagnostic challenge. Dermoscopy visualizes skin structures not normally visible to the naked eye, providing additional morphological information. Aims: The aim of this work was to study and evaluate the various dermoscopic patterns of different types of leprosy and lepra reactions and to assess their association with clinical and histopathology. Materials and Methods: A descriptive cross-sectional study was undertaken at dermatology OPD over 1.5 years after ethical approval. Thorough clinical, physical, local examination, and gross photographs were taken. Dermoscopy was taken and the images were analyzed for dermoscopic features. Biopsy from the same lesion was taken. Results: A total of 50 naïve cases of leprosy and lepra reactions with skin phototypes of IV to VI were studied. Males (30) outnumbered females (20). The most common type was Borderline tuberculoid Leprosy (BT) (21,42%). We observed yellowish-brown and white structureless areas histologically corresponding to dermal granulomatous infiltrate, whereas vascular findings predominantly of linear irregular vessels and variable loss of appendageal structures histologically corresponding to perivascular and periappendageal infiltrate respectively were predominant features throughout the spectrum. Appendageal structures were markedly reduced in the tuberculoid pole. We noted reduced pigmentary network towards tuberculoid pole whereas accentuation towards the lepromatous pole. Follicular plugging, scaling, and shiny white areas were additional features in the lepra reaction. Conclusion: Yellowish brown and white structureless areas, associated vascular findings predominantly of linear irregular vessels, and variable loss of appendageal structures were key features throughout the spectrum. Sunflower-like appearance, rosette-like pattern and milky red background in histoid leprosy, target-like pattern in type 2 lepra reaction were the unique dermoscopic findings from our study.