Background: Leprosy is the most ancient and widely spread global disease and was described in various articles of ancient civilizations. In 1990, the goal of eliminating leprosy by the end of the 20th century was proposed by the World Health Organization but still leprosy is highly prevalent in India. Leprosy is categorized in various types depending upon clinical features, histopathological findings and the host immunity. Various clinical features and acid fast bacilli demonstration in slit skin smears can help in diagnosis of leprosy but histopathological examination can help to classify and aid in the definitive diagnosis of leprosy and also prognosis of the disease and assessment of regression of the disease in patient undergoing treatment.
Aim: To classify all skin biopsies having clinical diagnosis of leprosy in to various types according to the Ridley Jopling’s classification of leprosy, also to find out the correlation between histopathological diagnosis of skin biopsies with clinical diagnosis of leprosy and to study various clinical presentations of leprosy with respect histopathological diagnosis.
Materials and Methods: It was a prospective study done in the Department of Pathology, Shri Bhausaheb Hire Government Medical College Dhule over a period of 24 months i.e. from 1st January 2022 to 31st December 2023. Skin punch biopsies from 288 clinically diagnosed patients of leprosy were subjected for routine processing and routine staining with Haematoxyline & Eosin stain as well as Fite-Faraco staining. The lesions were classified using the Ridley-Jopling’s classification into Tuberculoid Leprosy, Borderline Tuberculoid, Mid Borderline, Borderline Lepromatous and Lepromatous Leprosy. Few of the lesions were categorized as Histioid leprosy and Erythema Nodosum Leprosum
Result: There was a male predominance (59.02%) seen in our study. Most common age group affected was 21to 30yrs followed by 31to 40yrs. Most common histopathological diagnosis was Borderline Tuberculoid leprosy followed by Indeterminate leprosy. Most common clinical presentation was hypopigmented patches, hypoasthetic patches, erythematous patches and tingling and numbness. 100% Fite-Faraco stain positivity was noted in Lepromatous and Histioid leprosy. Clinicohistopathological concordance was 100% in Erythema Nodosum Leprosum, followed by Tuberculoid (94%) and Borderline Tuberculoid (90%). The concordance was minimum in Mid Borderline leprosy(33%).
Conclusion: Despite of implementation several government projects to control leprosy, leprosy still remains to be highly prevalent disease in India, also seen in this study, as we got 188 cases of leprosy over a period of 24 months. In our study we got high clinicohistopathological concordance in the diagnosis of Tuberculoid, Borderline Tuberculoid and Erythema Nodosum Leprosum cases. But it is low in the diagnosis of Midborderline and Indeterminate leprosy. There is overlapping of clinical features in various types of leprosy, so histopathological examination should be strongly recommended and considered as Gold standard for the diagnosis of leprosy.
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