@article{100228,
  keywords = {Leprosy, Immunohistochemistry, Nerve Fibers, Diagnosis, Differential},
  author = {Costa EAFD and Amadeu TP and Illarramendi X and Pascarelli B and Nery JADC and Sales AM and Antunes SLG},
  title = {Immunohistochemical and histopathological analyses of cutaneous innervation to improve the diagnostic efficacy in hansen disease skin lesion},
  abstract = {<p><strong>Background:</strong> The diagnosis of Hansen disease (HD) can be difficult when acid-fast bacilli are not detected in the patient's skin sample.</p>

<p><strong>Objective: </strong>To demonstrate that detailed morphological analysis of nonspecific inflammatory and/or noninflammatory alterations in dermal nerves as well as skin adnexa in leprosy-suspected biopsy samples could improve the efficacy of histopathological diagnosis.</p>

<p><strong>Methods: </strong>Patients with one to five skin lesions were enrolled in the study and classified into three groups by skin histopathology findings: Hansen disease (HD, n = 13), other diseases (OD, n = 11), and inconclusive cases (INC, n = 11). We quantified dermal nerve damage via the nerve lesion index (NLI) and PGP9.5-immunoreactive axon quantitative index in dermal nerves (AQI). We also measured inflammatory involvement of adnexa in cutaneous samples as indirect evidence of HD.</p>

<p><strong>Results: </strong>We observed a higher median endoneurial inflammatory infiltrate NLI (HD = 0.5; INC = 0; OD = 0; p &lt; 0.001) and more frequent inflammatory involvement of skin adnexa in samples of the HD group compared with those of the INC and OD groups (HD = 7; INC = 1; OD = 0). However, samples from the INC and OD groups also showed inflammatory and noninflammatory damage of dermal nerves, with 2 or more kinds of alterations in nerves in the same sample (respectively: INC = in 1 and 2 samples; OD = in 3 and 5 respectively). The quantification of PGP9.5-immunoreactive axons in dermal nerves revealed no difference between the groups.</p>

<p><strong>Conclusion: </strong>A detailed morphological analysis of cutaneous nerves in lesions with a suspicion of HD enabled us to select patients with nonspecific inflammatory or non-inflammatory lesions in the dermal nerves in the INC and OD groups, so they may be clinically monitored aiming at a possible future diagnosis of the disease. These INC and OD patients cannot have the HD diagnosis definitely excluded, and HD may coexist with another disease as a comorbidity.</p>
},
  year = {2024},
  journal = {Arquivos de Neuro-Psiquiatria},
  volume = {82},
  pages = {001-010},
  publisher = {Georg Thieme Verlag KG},
  issn = {0004-282X, 1678-4227},
  url = {https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0044-1787136.pdf},
  doi = {10.1055/s-0044-1787136},
  language = {ENG},
}