Leprosy differential diagnosis
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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]
Overview
Leprosy must be differentiated from other diseases that cause skin lesions, nodules, plaques paresthesias and nerve pain, such as autoimmune diseases, SLE, parasitic infections, vitiligo or cutaneous tuberculosis.
Differential diagnosis
Leprosy has a wide range of clinical manifestations, each with different degrees of intensity. Other diseases that may mimic, or have similar features of leprosy, include:[1]
- Congenital lesions - such as nevus depigmentosus are generally present at birth and do not present with changes in sensation.
- Vitiligo - a benign lesion that presents with depigmented areas, instead of hypopigmented.
- Pityriasis alba - may be hard to distinguish from leprosy, particularly in early stages of the second, however, it is a common skin condition, mostly occurring in children and usually seen as dry, fine scaled, pale patches on their faces.[2]
- Pityriasis versicolor - common skin infection caused by the yeast Malassezia furfur. This yeast is normally found on the human skin and only becomes troublesome under certain circumstances, such as a warm and humid environment, causing: generally oval or irregularly-shaped spots of 1/4 to 1 inch in diameter, often merging together to form a larger patch with a sharp border; occasional fine scaling of the skin producing a very superficial ash-like scale; and pale, dark tan, or pink in color spots, with a reddish undertone that can darken when the patient is overheated, such as in a hot shower or during/after exercise.
- Dermatophyte - parasitic fungus that infects the the skin, hair and nails due to its ability to obtain nutrients from keratinized material. The infection is usually restricted to the nonliving cornified layer of the epidermis because of their inability to penetrate viable tissue of an immunocompetent host.
- Systemic Lupus Erythematosus - potential fatal chronic autoimmune disease, common initial and chronic complaints include skin rash, fever, malaise, joint pains, myalgias and fatigue.
- Postinflammatory hypopigmented skin - a cutaneous condition characterized by decreased pigment in the skin following inflammatory reaction of the skin.
- Granuloma multiforme - a cutaneous condition most commonly seen in central Africa, and rarely elsewhere, characterized by skin lesions that are located predominantly on the upper trunk and arms in sun-exposed areas.[3]
- Cutaneous tuberculosis - a form of tuberculosis involving the skin. The diagnosis may be difficult, since this condition shares many similarities with other skin conditions. It may be caused by Mycobacterium tuberculosis, Mycobacterium bovis, and the BCG vaccination. Commonly the skin lesion begins as an irregular red-brown papule or nodule, with a granulomatous base. Later this lesion evolves into a painless ulcer, usually with ≤ 1cm of diameter. The most common sites of this lesion are: face and extremities.[4]
- Granuloma annulare - chronic skin disease, with unknown cause, consisting of a rash with reddish bumps arranged in a circle or ring. It most often affects children, young and older adults and it is slightly more common in females (60/40 ratio). The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease.
- Cutaneous leishmaniasis - a skin infection caused by a single-celled parasite that is transmitted by sand-fly bites the, constituting the most common form of leishmaniasis. The lesions typically progress from small papules to nodular plaques, and eventually lead to open sores with a raised border and central crater (ulcer), which can be covered with scales or [[crust]. These lesions are usually painless but can be painful, particularly if open sores become infected with bacteria. Satellite lesions, regional lymphadenopathy (swollen glands), and nodular lymphangitis can be noted. Commonly this condition produces less nodules than the lepromatous form of leprosy, with the skin lesions commonly resolving after a few weeks, which is uncommon in leprosy.
- Post kala-azar dermal leishmaniasis - may mimic leprosy in its presentation with hypopigmented macules, papules and nodular lesions.
- Mycosis fungoides - is a rare form of cutaneous T-cell non-Hodgkin's lymphoma, generally affects the skin, but may progress internally over time. Common symptoms include rashlike patches, tumors, or lesions and pruritus in about 20% of patients.
- Hereditary sensory motor neuron neuropathy type III - commonly causes nerve thickening, which is present in leprosy and may therefore complicate the diagnosis.
- Refsum's disease - like hereditary sensory motor neuron neuropathy type III, it commonly causes nerve thickening, which is present in leprosy and may therefore complicate the diagnosis.
- Amyloid - insoluble fibrous protein aggregations sharing specific structural traits. Is able to cause a wide spectrum of symptoms, of which skin changes is a common form of presentation. These include: petechiae, ecchymoses, [[waxy papular nodules around the eyes, neck and in the groin region, patches of hair loss and brittle nails. May be a complication of leprosy and be responsible for part of the nerve thickening seen in this condition.
- Mycosis - may be classified according to the affected tissue. When it affects the superficial and more inner layers of skin it may mimic leprosy.
- Keloid - A keloid is a type of scar which results in an overgrowth of tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to flesh-colored or red to dark brown in color.
References
- ↑ 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.
- ↑ Pinto FJ, Bolognia JL (1991). "Disorders of hypopigmentation in children". Pediatr. Clin. North Am. 38 (4): 991–1017. PMID 1870914.
- ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ↑ MacGregor RR (1995). "Cutaneous tuberculosis". Clin Dermatol. 13 (3): 245–55. PMID 8521366.