Leprosy
Mailing List, November 7th, 2008
Ref.: Histoid leprosy and
Granuloma fraction
From: Faber W. R., Amsterdam,
The Netherlands
Dear Dr
Ranawaka,
I refer to your LML message dated Oct. 31st, 2008. That is an interesting
observation of a patient developing histoid lesions during treatment.
Recently, we treated a patient diagnosed with borderline lepromatous
(BL) leprosy who besides the typical BL lesions also had scattered
nodular lesions on the extremities: shown by histopathology to be
histoid leprosy. As there
was a high bacteriological index (BI) we treated him with a long
course of multi-drug therapy (MDT). Due
to poor compliance we could not definitely state the duration of
treatment but we calculated it to be around 24 months. At that time the histoid
lesions had flattened, and the BI of the skin biopsy was zero. In this case treatment with
standard MDT for around 24 months was effective in curing his (histoid)
leprosy.
I would
advise you to take biopsies to monitor the result of your treatment by
means of BI and Granuloma Fraction *.
With kind regards,
William R.
Faber, MD, PhD
Professor of
Tropical Dermatology
Academic
Medical
Center
University
of
Amsterdam
Meibergdreef
9
1105 AZ
Amsterdam
The
Netherlands
F: 31 - 20
696 0076
email: w.r.faberatamc.uva.nl
*Granuloma
Fraction (GF) is the fraction of the dermis in a section occupied by
granuloma, and observed under a low-power objective. You can express it
numerically, as proposed by Ridley, on a scale from 1.0 down to 0.1. Personally, I prefer to
express it in percentage as this is easier to recall by the residents. The fall in GF in consecutive
follow up biopsies gives a measure of the effect, and effectiveness,
of treatment. It is in my
opinion especially useful in BI negative patients.
Reference: Dennis S. Ridley "Skin Biopsy in
Leprosy"; Third Edition 1990, page 59, Documenta Geigy, © 1977
CIBA-GEIGY Limited,
Basle
,
Switzerland
.
