Clinico-Epidemiological Profile of Histoid Leprosy: A Prospective Study

Abstract

Introduction: Described for the first time by Wade in 1960, considered by some as a variant of Lepromatous Leprosy and accepted by others as a distinct entity, Histiod leprosy is characterized by cutaneous and subcutaneous nodules and plaques present over apparently normal skin. The presence of spindle shaped cells on histopathology, the absence of globi inspite of having high bacillary index and rarity of type II reactions despite being on lepromatous pole of Ridley Jopling classification makes this variety a unique entity. Increase in the number of such cases prompted us to study the Clinico-epidemiological profile of patients diagnosed as Histoid leprosy in our out -patient Department. Aim: To study Clinico-epidemiological profile of patients diagnosed as having Histoid Leprosy between the period of April 2015 to march 2017 in the Department of Dermatology Venereology and leprosy. Method: A prospective study of newly diagnosed patients with Histoid Leprosy on the basis of clinical, bacteriological and histopathological features was conducted during a period of 2 years. The demographic and other parameters were analysed from prescribed case record forms. Results: 420 new cases of leprosy were registered in the Department during the period of 2 years. Histoid Leprosy was seen in 20 patients (4.7%). Mean age of 37.8 years along with male preponderance (M: F-3:1) was observed. Approximately 90% of patients did not receive any anti Hansens treatment in the past. De novo Histoid lesions appeared in 75% of patients. Three (15%) patients developed type II lepra reaction (ENL) and two of them had deformity during their first visit. Conclusion: The absence of typical patches of leprosy, pain or itching delays the consultation by the patient thereby posing high risk of transmission to others members of the family. Absence of knowledge in leprosy workers and Medical officers regarding this variant having high bacillary load enhances the risk of missing the detection of Histiod variant. High incidence of Histoid leprosy in our tertiary centre emphasizes the need of house to house survey on regular basis.