Leprosy classification: Difference between revisions

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__NOTOC__
__NOTOC__
{{Leprosy}}
{{Leprosy}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}}; {{AE}} {{JS}}{{KS}}


==Overview==
==Overview==
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==Classification==
==Classification==
Leprosy may present with a variety of [[clinical]], [[histopathological]] and [[bacterial]] manifestations. Different classes of Leprosy type determine [[prognosis]], infectivity rate and the appropriate [[Therapy|treatment]].<ref name="WalkerLockwood2007">{{cite journal|last1=Walker|first1=Stephen L.|last2=Lockwood|first2=Dina N.J.|title=Leprosy|journal=Clinics in Dermatology|volume=25|issue=2|year=2007|pages=165–172|issn=0738081X|doi=10.1016/j.clindermatol.2006.05.012}}</ref>
There are different systems for classifying leprosy. However, the two more common classification schemes include the ''[[WHO]]'' and the ''Ridley-Jopling'' systems.
 
There are different systems for classifying leprosy. However, the two more common include the ''[[WHO]]'' and the ''Ridley-Jopling''.


{| class="wikitable"
{| class="wikitable"
Line 22: Line 20:
|-
|-
| Paucibacillary
| Paucibacillary
| tuberculoid ("TT"), borderline tuberculoid ("BT")
| Tuberculoid ("TT"), Borderline Tuberculoid ("BT")
| A30.1, A30.2
| A30.1, A30.2
| Tuberculoid
| Tuberculoid
| It is characterized by one or more [[Hypopigmentation|hypopigmented]] skin [[macule]]s and anaesthetic patches, where skin [[Wikt:sensation|sensations]] are lost because of damaged peripheral nerves that have been attacked by the human host's immune cells.
| It is characterized by one or more [[Hypopigmentation|hypopigmented]] [[skin]] [[macule]]s and anaesthetic patches, where [[skin]] sensations are lost because of damaged [[peripheral nerves]] that have been attacked by the host's [[immune cells]].
| Positive
| Positive
| bacillus (Th1)
| Bacillus (Th1)
|-
|-
| Multibacillary
| Multibacillary
| midborderline or borderline ("BB")
| Midborderline or Borderline ("BB")
| A30.3
| A30.3
| Borderline
| Borderline
| Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become more like lepromatous leprosy or may undergo a reversal reaction, becoming more like the tuberculoid form.
| Borderline leprosy is of intermediate severity and is the most common form. [[Skin lesions]] resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and [[peripheral nerve]] involvement with [[weakness]] and [[loss of sensation]] is common. This type is unstable and may become lepromatous, or may undergo a reversal reaction, becoming more like the tuberculoid form.
|
|
|
|
|-
|-
| Multibacillary
| Multibacillary
| borderline lepromatous ("BL"), and lepromatous ("LL")
| Borderline Lepromatous ("BL"), and Lepromatous ("LL")
| A30.4, A30.5
| A30.4, A30.5
| Lepromatous
| Lepromatous
| It is associated with symmetric skin [[lesion]]s, [[Nodule (medicine)|nodules]], [[plaque]]s, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and [[epistaxis]] (nose bleeds), but, typically, detectable nerve damage is late.
| It is associated with symmetric skin [[lesion]]s, [[nodules]], [[plaque]]s, thickened [[dermis]] and frequent involvement of the [[nasal mucosa]] resulting in [[nasal congestion]] and [[epistaxis]] but detectable [[nerve]] damage is late.
| Negative
| Negative
| plasmid inside bacillus (Th2)
| Plasmid inside Bacillus (Th2)
|}
|}


==Ridley Jopling classification==
==Ridley Jopling Classification==
There are 5 classes in the Ridley Jopling classification scheme.  
 
===Tuberculoid or Pauci-bacillary Pole===
There are 6 classes in the Ridley Jopling classification scheme. This classification is based on the following:<ref name="pmid17366457">{{cite journal| author=Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH| title=Methods for the classification of leprosy for treatment purposes. | journal=Clin Infect Dis | year= 2007 | volume= 44 | issue= 8 | pages= 1096-9 | pmid=17366457 | doi=10.1086/512809 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17366457  }} </ref>  
This is the least severe form of the [[disease]].  In this form of the disease the following are present:
* [[Cutaneous]] elements
*1 to 3 well-defined [[lesions]] with a central [[hypopigmented area]], with [[hypoesthesia]], a well-developed [[immune response]] from the patient, with evidence of an adequate [[granulomatous]] [[inflammation]] and presence of very few [[acid-fast bacilli]]; to the ''lepromatous or multi-bacillary pole'', in which patients presents with numerous undefined [[nodular]] [[lesions]] throughout the [[body]], with a weak [[immune response]] towards the [[bacteria]], [[histological]] evidence of foamy [[macrophages]] in [[dermis]] filled with a great number of [[mycobacteria]]. On this last pole, it is important to notice that even though the [[immune system]] is not capable of mounting an [[immune response]] towards the [[bacilli]], patients are still [[immunocompetent]] for other [[diseases]]. For this classification contribute the following elements:<ref name="pmid17366457">{{cite journal| author=Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH| title=Methods for the classification of leprosy for treatment purposes. | journal=Clin Infect Dis | year= 2007 | volume= 44 | issue= 8 | pages= 1096-9 | pmid=17366457 | doi=10.1086/512809 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17366457  }} </ref>  
* [[Neurological]] elements
* [[Cutaneous]]
* [[Neurological]]
* [[Biopsy]] findings
* [[Biopsy]] findings
* [[Immunological]] status
* [[Immunological]] status
* Sum of [[acid-fast bacilli]] in the [[dermis]].
* Presence of [[acid-fast bacilli]] in [[dermis]]
Between these two poles, there is also the ''intermediate, dimorphous or borderline state''. This last category is subdivided into 3 subcategories, depending on the pole each subcategory has more similarities with, which include:
 
* Borderline Tuberculoid, or BT
===Tuberculoid or Paucibacillary Pole===
* Mid-Borderline, Borderline-Borderline, or BB
This is the least severe form of the disease. In this form of the disease the following are present:
* Borderline Lepromatous, or BL
* 1 to 3 well-defined [[lesions]] with central [[hypopigmented area]] and [[hypoesthesia]]
This intermediate category is considered to be the one where the [[disease]] usually begins. It will then progress to one of the poles: <ref name="WalkerLockwood2007">{{cite journal|last1=Walker|first1=Stephen L.|last2=Lockwood|first2=Dina N.J.|title=Leprosy|journal=Clinics in Dermatology|volume=25|issue=2|year=2007|pages=165–172|issn=0738081X|doi=10.1016/j.clindermatol.2006.05.012}}</ref>
* Well-developed [[immune response]]
* In case of progression towards the ''tuberculoid pole'', it means the patient's [[Cell-mediated immunity|cell-mediated immunity]] is increasing, thereby being associated with [[inflammation]] of the [[nerves]] and [[skin]].
* [[Granulomatous]] [[inflammation]]
* In case of progression towards the ''lepromatous pole'', usually occurring before [[Therapy|treatment]] is initiated and is compatible with loss of [[Cell-mediated immunity|cell-mediated immunity]].
* Rare [[acid-fast bacilli]]
Some patients show evidence of early unspecific [[lesions]] and [[nerve]] infiltrates, lacking the required criteria for being classified as above mentioned. These patients are included in a specific category called ''indeterminate''. This category should only be used when there is [[diagnostic]] proof of leprosy, from a [[biopsy]] sample showing evidence of [[mycobacteria leprae]] and [[perineural]] infiltrates, but the disease is not advanced enough to show the clear patient position in the leprosy classification.
====Skin====
=====Ear=====
<gallery>
Image:Tuberculoid leprosy40.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy81.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
</gallery>
 
=====Trunk=====
 
<gallery>
 
Image:Tuberculoid leprosy06.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy17.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy18.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy27.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy36.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy41.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy45.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy49.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy50.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy56.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy57.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy58.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy62.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy63.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy64.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy65.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy66.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy88.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
</gallery>
 
=====Extremity=====
 
<gallery>
 
Image:Tuberculoid leprosy01.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy02.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy03.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy04.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy07.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy08.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy10.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy11.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy12.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy13.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy14.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy16.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy19.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy20.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy25.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy31.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy32.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy34.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy35.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy37.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy38.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy39.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy42.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy43.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy44.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy51.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy52.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy53.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy54.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy55.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy67.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy68.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy69.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy70.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy71.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy73.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy74.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy77.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy78.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy75.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy79.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy80.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy82.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy83.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy84.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy86.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy87.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
</gallery>
 
=====Genitalia=====
 
<gallery>
 
Image:Tuberculoid leprosy21.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy22.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy23.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Tuberculoid leprosy24.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy48.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy47.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy59.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy60.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy61.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
=====Head=====
 
<gallery>
 
Image:Tuberculoid leprosy28.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy29.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy30.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Tuberculoid leprosy33.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Gluteal Region=====
<gallery>
 
 
Image:Tuberculoid leprosy05.jpg|Tuberculoid leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
</gallery>
=====Nodular leprosy of childhood=====
======Face======
<gallery>
Image:Nodular leprosy of childhood01.jpg|Nodular leprosy of childhood. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
======Trunk======
<gallery>
Image:Nodular leprosy of childhood02.jpg|Nodular leprosy of childhood. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Nodular leprosy of childhood03.jpg|Nodular leprosy of childhood. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
===Lepromatous or Multi-Bacillary Pole===
In this form of the disease the following are present:
* Multiple undefined [[nodular]] [[lesions]] throughout the [[body]]
* Weak [[immune response]]
* Evidence of [[Foam cell|foamy]] [[macrophages]] in [[dermis]] filled with [[mycobacteria]]
* Patients are [[immunocompetent]], despite not being able to fight [[mycobacterium leprae]]
====Skin====
=====Face=====
<gallery>
Image:Lepromatous leprosy01.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy02.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy11.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy12.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy17.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy22.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy25.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy34.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy82.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy85.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy93.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy94.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy95.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
=====Trunk=====
 
<gallery>
 
Image:Lepromatous leprosy03.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy04.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy05.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy06.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy07.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy08.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy14.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy29.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy37.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy38.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy39.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy41.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy42.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy43.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy44.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy45.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy47.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy57.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy59.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy60.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy61.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy63.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy64.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy69.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy70.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy71.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy77.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy78.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy86.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy87.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy88.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy90.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy89.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy92.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy96.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy97.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy98.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
=====Extremity=====
 
<gallery>
 
Image:Lepromatous leprosy10.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy13.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy15.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy16.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy19.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy20.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy21.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy24.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy26.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy30.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy31.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy32.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy33.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy46.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy48.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy49.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy50.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy51.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy52.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy53.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy54.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy55.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy56.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy58.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy62.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy65.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy66.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy67.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy68.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy72.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy73.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy74.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy75.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
 
Image:Lepromatous leprosy76.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy79.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy80.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy81.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy91.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy99.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy100.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy101.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
=====Ear=====
 
Image:Lepromatous leprosy09.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy18.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy23.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy27.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy28.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy35.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy36.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy40.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lepromatous leprosy83.jpg|Lepromatous leprosy. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
 
===Intermediate, Dimorphous or Borderline State===
This last category is divided into 3 subcategories:
====Borderline Tuberculoid, or BT====
In this form of the disease the following are present:
 
* Progression towards the ''tuberculoid pole''
* Increasing [[Cell-mediated immunity|cell-mediated immunity]]
* [[Inflammation]] of the [[nerves]] and [[skin]]
 
====Mid-Borderline, Borderline-Borderline, or BB====
This is considered to be where the [[disease]] usually begins, progressing towards one of the poles afterwards.<ref name="WalkerLockwood2007">{{cite journal|last1=Walker|first1=Stephen L.|last2=Lockwood|first2=Dina N.J.|title=Leprosy|journal=Clinics in Dermatology|volume=25|issue=2|year=2007|pages=165–172|issn=0738081X|doi=10.1016/j.clindermatol.2006.05.012}}</ref>
====Borderline Lepromatous, or BL====
In this form of the disease the following are present:
* Progression towards the ''lepromatous pole''
* Common before [[Therapy|treatment]] initiation
* Loss of [[Cell-mediated immunity|cell-mediated immunity]]
 
===Indeterminate===
In this form of the disease the following are present:
* Early unspecific [[lesions]]
* [[Nerve]] infiltrates, lacking required criteria for being classified as above mentioned
* Used only when there is [[diagnostic]] proof of leprosy, from a [[biopsy]] sample, with evidence of [[mycobacterium leprae]] and perineural infiltrates but the disease is not advanced enough to show the clear patient position in the leprosy classification.
====Skin====
=====Extremity=====
<gallery>
Image:Indeterminate leprosy01.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy02.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy04.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy05.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy06.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy07.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy08.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy09.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
Image:Indeterminate leprosy10.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
</gallery>
 
=====Trunk=====
 
<gallery>
 
Image:Indeterminate leprosy03.jpg|Indeterminate leprosr. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
</gallery>


==WHO classification==
==WHO classification==
The [[WHO]] organization has defined a more simple and straightforward classification, according to the number of [[skin lesions]] present. This classification is due to be used when there is lack of [[laboratory]] support or clinical expertise, in which case, the [[disease]] will be classified as ''paucibacillary leprosy'' or ''multibacillary leprosy''. However, despite useful in certain occasions, this method may lead to misclassification of some patients, resulting in undertreatment of some cases.<ref name="pmid17366457">{{cite journal| author=Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH| title=Methods for the classification of leprosy for treatment purposes. | journal=Clin Infect Dis | year= 2007 | volume= 44 | issue= 8 | pages= 1096-9 | pmid=17366457 | doi=10.1086/512809 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17366457  }} </ref>
The [[WHO]] organization classification scheme is simpler, and it is based upon the number of [[skin lesions]]. This simpler classification scheme can be applied in the absence of [[laboratory]] support or clinical expertise. It allows a rapid [[diagnosis]], selection and initiation of [[Therapy|treatment]]. The leprosy subtypes include:<ref name=WHO>{{cite web | title = Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015) | url = http://www.searo.who.int/entity/global_leprosy_programme/documents/enhanced_global_strategy_2011_2015_operational_guidelines.pdf }}</ref><ref name="pmid17366457">{{cite journal| author=Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH| title=Methods for the classification of leprosy for treatment purposes. | journal=Clin Infect Dis | year= 2007 | volume= 44 | issue= 8 | pages= 1096-9 | pmid=17366457 | doi=10.1086/512809 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17366457  }} </ref>
 
This classification allows, however, for a rapid [[diagnosis]], selection and initiation of [[Therapy|treatment]], according to the class of leprosy:<ref name=WHO>{{cite web | title = Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015) | url = http://www.searo.who.int/entity/global_leprosy_programme/documents/enhanced_global_strategy_2011_2015_operational_guidelines.pdf }}</ref>


===Paucibacillary or PB===
===Paucibacillary or PB===
:* Higher level of [[immunity]].
:* Higher level of [[immunity]]
:* Lower number of ''[[bacilli]]''.
:* Lower number of ''[[bacilli]]''
:* Up to five [[skin lesions]] in total [[body]] examination.
:* Up to five [[skin lesions]] in total [[body]] examination
:* Requires less intensive [[Therapy|treatment]] - ''will need two instead of three antileprosy [[drugs]], for a shorter period of time''.
:* Requires less intensive [[Therapy|treatment]]


===Multibacillary or MB===
===Multibacillary or MB===
:* Lower level of [[immunity]].
:* Lower level of [[immunity]]
:* Higher number of ''[[bacilli]]''.
:* Higher number of ''[[bacilli]]''
:* Six or more [[skin lesions]] in total [[body]] examination.
:* Six or more [[skin lesions]] in total [[body]] examination
:* Requires intensive [[Therapy|treatment]] - ''will need three instead of two antileprosy [[drugs]], for a longer period of time''.
:* Requires intensive [[Therapy|treatment]]


If a [[skin]] smear is done and shows a positive result, then that patient will immediately be classified as a ''multibacillary'' patient, irrespective of the number of [[skin lesions]] identified on [[physical examination]].
If a [[skin]] smear is done and shows a positive result, then that patient will immediately be classified as ''multibacillary'', irrespective of the number of [[skin lesions]] identified on [[physical examination]]. Despite its ease of use, this classification scheme may unfortunately mis-classify some patients resulting in under treatment of those cases.


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Infectious disease]]
 
[[Category:Tropical disease]]
[[Category:Tropical disease]]
[[Category:Leprosy]]
[[Category:Leprosy]]

Latest revision as of 18:10, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]Kiran Singh, M.D. [3]

Overview

The Ridley Jopling classification and the WHO classification are the two most widely used systems to classify Leprosy. These classification systems are based on clinical, microbiologic and histopathological features, and are used to determine the patient's prognosis and the treatment regimen.[1][2][3]

Classification

There are different systems for classifying leprosy. However, the two more common classification schemes include the WHO and the Ridley-Jopling systems.

WHO Ridley-Jopling ICD-10 MeSH Description Lepromin test Immune target
Paucibacillary Tuberculoid ("TT"), Borderline Tuberculoid ("BT") A30.1, A30.2 Tuberculoid It is characterized by one or more hypopigmented skin macules and anaesthetic patches, where skin sensations are lost because of damaged peripheral nerves that have been attacked by the host's immune cells. Positive Bacillus (Th1)
Multibacillary Midborderline or Borderline ("BB") A30.3 Borderline Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become lepromatous, or may undergo a reversal reaction, becoming more like the tuberculoid form.
Multibacillary Borderline Lepromatous ("BL"), and Lepromatous ("LL") A30.4, A30.5 Lepromatous It is associated with symmetric skin lesions, nodules, plaques, thickened dermis and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis but detectable nerve damage is late. Negative Plasmid inside Bacillus (Th2)

Ridley Jopling Classification

There are 6 classes in the Ridley Jopling classification scheme. This classification is based on the following:[4]

Tuberculoid or Paucibacillary Pole

This is the least severe form of the disease. In this form of the disease the following are present:

Skin

Ear
Trunk
Extremity
Genitalia
Head
Gluteal Region
Nodular leprosy of childhood
Face
Trunk

Lepromatous or Multi-Bacillary Pole

In this form of the disease the following are present:

Skin

Face
Trunk
Extremity
Ear

Image:Lepromatous leprosy09.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy18.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy23.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy27.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy28.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy35.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy36.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy40.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy83.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] </gallery>

Intermediate, Dimorphous or Borderline State

This last category is divided into 3 subcategories:

Borderline Tuberculoid, or BT

In this form of the disease the following are present:

Mid-Borderline, Borderline-Borderline, or BB

This is considered to be where the disease usually begins, progressing towards one of the poles afterwards.[1]

Borderline Lepromatous, or BL

In this form of the disease the following are present:

Indeterminate

In this form of the disease the following are present:

  • Early unspecific lesions
  • Nerve infiltrates, lacking required criteria for being classified as above mentioned
  • Used only when there is diagnostic proof of leprosy, from a biopsy sample, with evidence of mycobacterium leprae and perineural infiltrates but the disease is not advanced enough to show the clear patient position in the leprosy classification.

Skin

Extremity
Trunk

WHO classification

The WHO organization classification scheme is simpler, and it is based upon the number of skin lesions. This simpler classification scheme can be applied in the absence of laboratory support or clinical expertise. It allows a rapid diagnosis, selection and initiation of treatment. The leprosy subtypes include:[6][4]

Paucibacillary or PB

Multibacillary or MB

If a skin smear is done and shows a positive result, then that patient will immediately be classified as multibacillary, irrespective of the number of skin lesions identified on physical examination. Despite its ease of use, this classification scheme may unfortunately mis-classify some patients resulting in under treatment of those cases.

References

  1. ↑ 1.0 1.1 Walker, Stephen L.; Lockwood, Dina N.J. (2007). "Leprosy". Clinics in Dermatology. 25 (2): 165–172. doi:10.1016/j.clindermatol.2006.05.012. ISSN 0738-081X.
  2. ↑ Eichelmann, K.; González González, S.E.; Salas-Alanis, J.C.; Ocampo-Candiani, J. (2013). "Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment". Actas Dermo-Sifiliográficas (English Edition). 104 (7): 554–563. doi:10.1016/j.adengl.2012.03.028. ISSN 1578-2190.
  3. ↑ Bhat, Ramesh Marne; Prakash, Chaitra (2012). "Leprosy: An Overview of Pathophysiology". Interdisciplinary Perspectives on Infectious Diseases. 2012: 1–6. doi:10.1155/2012/181089. ISSN 1687-708X.
  4. ↑ 4.0 4.1 Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH (2007). "Methods for the classification of leprosy for treatment purposes". Clin Infect Dis. 44 (8): 1096–9. doi:10.1086/512809. PMID 17366457.
  5. ↑ 5.000 5.001 5.002 5.003 5.004 5.005 5.006 5.007 5.008 5.009 5.010 5.011 5.012 5.013 5.014 5.015 5.016 5.017 5.018 5.019 5.020 5.021 5.022 5.023 5.024 5.025 5.026 5.027 5.028 5.029 5.030 5.031 5.032 5.033 5.034 5.035 5.036 5.037 5.038 5.039 5.040 5.041 5.042 5.043 5.044 5.045 5.046 5.047 5.048 5.049 5.050 5.051 5.052 5.053 5.054 5.055 5.056 5.057 5.058 5.059 5.060 5.061 5.062 5.063 5.064 5.065 5.066 5.067 5.068 5.069 5.070 5.071 5.072 5.073 5.074 5.075 5.076 5.077 5.078 5.079 5.080 5.081 5.082 5.083 5.084 5.085 5.086 5.087 5.088 5.089 5.090 5.091 5.092 5.093 5.094 5.095 5.096 5.097 5.098 5.099 5.100 5.101 5.102 5.103 5.104 5.105 5.106 5.107 5.108 5.109 5.110 5.111 5.112 5.113 5.114 5.115 5.116 5.117 5.118 5.119 5.120 5.121 5.122 5.123 5.124 5.125 5.126 5.127 5.128 5.129 5.130 5.131 5.132 5.133 5.134 5.135 5.136 5.137 5.138 5.139 5.140 5.141 5.142 5.143 5.144 5.145 5.146 5.147 5.148 5.149 5.150 5.151 5.152 5.153 5.154 5.155 5.156 5.157 5.158 5.159 5.160 5.161 5.162 5.163 5.164 5.165 5.166 5.167 5.168 5.169 5.170 5.171 5.172 5.173 5.174 5.175 5.176 5.177 5.178 5.179 5.180 5.181 5.182 5.183 "Dermatology Atlas".
  6. ↑ "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).


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