02957nas a2200265   4500000000100000008004100001260002700042653001200069653002500081653001700106653002800123100001500151700001400166700001900180700001700199700001400216700001300230700001600243245014500259856008500404300001200489490000700501520215800508022002502666       2024                            d  bGeorg Thieme Verlag KG10aLeprosy10aImmunohistochemistry10aNerve Fibers10aDiagnosis, Differential1 aCosta EAFD1 aAmadeu TP1 aIllarramendi X1 aPascarelli B1 aNery JADC1 aSales AM1 aAntunes SLG00aImmunohistochemical and histopathological analyses of cutaneous innervation to improve the diagnostic efficacy in hansen disease skin lesion  uhttps://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0044-1787136.pdf  a001-0100 v823 a<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>
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