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Latest revision as of 18:10, 18 September 2017

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]

Cutaneous elements
Neurological elements
Biopsy findings
Immunological status
Presence of acid-fast bacilli in dermis

Tuberculoid or Paucibacillary Pole

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

1 to 3 well-defined lesions with central hypopigmented area and hypoesthesia
Well-developed immune response
Granulomatous inflammation
Rare acid-fast bacilli

Skin

Nodular leprosy of childhood

Face

Nodular leprosy of childhood. Adapted from Dermatology Atlas.^[5]

Trunk

Nodular leprosy of childhood. Adapted from Dermatology Atlas.^[5]
Nodular leprosy of childhood. Adapted from Dermatology Atlas.^[5]

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 foamy macrophages in dermis filled with mycobacteria
Patients are immunocompetent, despite not being able to fight mycobacterium leprae

Skin

Face

Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]

Trunk

Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]

Extremity

Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]
Lepromatous leprosy. Adapted from Dermatology Atlas.^[5]

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:

Progression towards the tuberculoid pole
Increasing 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.^[1]

Borderline Lepromatous, or BL

In this form of the disease the following are present:

Progression towards the lepromatous pole
Common before treatment initiation
Loss of 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

Indeterminate leprosr. Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite

Indeterminate leprosr. Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite

Trunk

Indeterminate leprosr. Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite

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

Higher level of immunity
Lower number of bacilli
Up to five skin lesions in total body examination
Requires less intensive treatment

Multibacillary or MB

Lower level of immunity
Higher number of bacilli
Six or more skin lesions in total body examination
Requires intensive treatment

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

↑ ^1.0 ^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.
↑ 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.
↑ 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.
↑ ^4.0 ^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.
↑ ^5.000 ^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".
↑ "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).

Template:WikiDoc Sources

[WalkerLockwood2007-1] 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.

[EichelmannGonzález_González2013-2] 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.

[BhatPrakash2012-3] 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.

[pmid17366457-4] 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.

[Dermatology_Atlas-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".

[WHO-6] "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).

[1]

[2]

[3]

[4]

[5]

[6]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Leprosy}}
-{{CMG}}; {{AE}} {{JS}}
+{{CMG}}; {{AE}} {{JS}}{{KS}}
 ==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 [[Therapy|treatment]] regimen.<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><ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref><ref name="BhatPrakash2012">{{cite journal|last1=Bhat|first1=Ramesh Marne|last2=Prakash|first2=Chaitra|title=Leprosy: An Overview of Pathophysiology|journal=Interdisciplinary Perspectives on Infectious Diseases|volume=2012|year=2012|pages=1–6|issn=1687-708X|doi=10.1155/2012/181089}}</ref>
+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]], [[microbiological|microbiologic]] and [[histopathological]] features, and are used to determine the patient's [[prognosis]] and the [[Therapy|treatment]] regimen.<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><ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref><ref name="BhatPrakash2012">{{cite journal|last1=Bhat|first1=Ramesh Marne|last2=Prakash|first2=Chaitra|title=Leprosy: An Overview of Pathophysiology|journal=Interdisciplinary Perspectives on Infectious Diseases|volume=2012|year=2012|pages=1–6|issn=1687-708X|doi=10.1155/2012/181089}}</ref>
 ==Classification==
-Leprosy may present among different patients, or even in one single patient throughout the course of the disease, with a multitude of [[clinical]], [[histopathological]] and [[bacterial]] states. By attributing a class to a certain manifestation of the [[disease]] in one patient, it is possible to determine his [[prognosis]], [[infectivity rate]] and the type of [[Therapy|treatment]] to administrate in that patient. <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 several different approaches for classifying leprosy however, some similarities do exist:
-* The [[World Health Organization]] system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria<ref>{{cite web |author=Smith DS | url=http://emedicine.medscape.com/article/220455-overview |title=Leprosy: Overview | work=eMedicine Infectious Diseases |date=2008-08-19|accessdate=2010-02-01}}</ref>
-* The SHAY scale provides five gradations.<ref name="pm hippopotamus id15176024">{{cite journal |author=Singh N, Manucha V, Bhattacharya SN, Arora VK, Bhatia A |title=Pitfalls in the cytological classification of borderline leprosy in the Ridley-Jopling scale |journal=Diagn. Cytopathol. |volume=30 |issue=6 |pages=386–8 |year=2004 |month=June |pmid=15176024 |doi=10.1002/dc.20012 |url= }}</ref><ref name="pmid5950347">{{cite journal |author=Ridley DS, Jopling WH |title=Classification of leprosy according to immunity. A five-group system |journal=Int. J. Lepr. Other Mycobact. Dis. |volume=34 |issue=3 |pages=255–73 |year=1966 |pmid=5950347 |doi= |url= }}</ref>
-* The [[ICD-10]], though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry.<ref name="news-medical">"What Is Leprosy?" THE MEDICAL NEWS | from News-Medical.Net - Latest Medical News and Research from Around the World. Web. 20 Nov. 2010. <http://www.news-medical.net/health/What-is-Leprosy.aspx>.</ref>
-* In [[Medical Subject Headings|MeSH]], three groupings are used.
 {| class="wikitable"
@@ Line 26: / Line 20: @@
 |-
 | Paucibacillary
-| tuberculoid ("TT"), borderline tuberculoid ("BT")
+| Tuberculoid ("TT"), Borderline Tuberculoid ("BT")
 | A30.1, A30.2
 | 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
-| bacillus (Th1)
+| Bacillus (Th1)
 |-
 | Multibacillary
-| midborderline or borderline ("BB")
+| 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 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
-| borderline lepromatous ("BL"), and lepromatous ("LL")
+| Borderline Lepromatous ("BL"), and Lepromatous ("LL")
 | A30.4, A30.5
 | Lepromatous
-| It is associated with symmetric skin [[lesion]]s, [[Nodule (medicine)|nodules]], [[Plaque (dermatology)|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
-| plasmid inside bacillus (Th2)
+| Plasmid inside Bacillus (Th2)
 |}
-However, the two most common classifications include:
+==Ridley Jopling Classification==
-===Ridley Jopling classification===
-This classification provides an optimal organization of the different presentations of the disease, being able to include [[clinic]], [[histopathology]] and [[bacterial]] index in each category, thereby providing an insight of the patient's [[immune response]] to the [[disease]]. <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> The status of [[disease]] will range from the ''tuberculoid or pauci-bacillary pole'', in which is present 1 to 3 well-defined [[lesions]] with a central hipopigmented area, with [[hipoesthesia]], 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>
+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>
-* [[Cutaneous]]
+* [[Cutaneous]] elements
-* [[Neurological]]
+* [[Neurological]] elements
 * [[Biopsy]] findings
 * [[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>
-===WHO classification===
+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>
-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>
+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>
-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>
+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>
-* '''Paucibacillary or PB''' will show:
+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>
-:* Higher level of [[immunity]].
+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>
-:* Lower number of ''[[bacilli]]''.
+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>
-:* 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''.
-* '''Multibacillary or MB''' will show:
+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>
-:* Lower level of [[immunity]].
-:* Higher number of ''[[bacilli]]''.
-:* 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''.
-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]].
+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==
+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>
+===Paucibacillary or PB===
+:* Higher level of [[immunity]]
+:* Lower number of ''[[bacilli]]''
+:* Up to five [[skin lesions]] in total [[body]] examination
+:* Requires less intensive [[Therapy|treatment]]
+===Multibacillary or MB===
+:* Lower level of [[immunity]]
+:* Higher number of ''[[bacilli]]''
+:* Six or more [[skin lesions]] in total [[body]] examination
+:* Requires intensive [[Therapy|treatment]]
+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==
@@ Line 94: / Line 488: @@
 [[Category:Disease]]
 [[Category:Dermatology]]
-[[Category:Infectious disease]]
 [[Category:Tropical disease]]
 [[Category:Leprosy]]

Leprosy classification: Difference between revisions

Latest revision as of 18:10, 18 September 2017

Overview

Classification

Ridley Jopling Classification

Tuberculoid or Paucibacillary Pole

Skin

Ear

Trunk

Extremity

Genitalia

Head

Gluteal Region

Nodular leprosy of childhood

Face

Trunk

Lepromatous or Multi-Bacillary Pole

Skin

Face

Trunk

Extremity

Ear

Intermediate, Dimorphous or Borderline State

Borderline Tuberculoid, or BT

Mid-Borderline, Borderline-Borderline, or BB

Borderline Lepromatous, or BL

Indeterminate

Skin

Extremity

Trunk

WHO classification

Paucibacillary or PB

Multibacillary or MB

References

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