Pure neuritic leprosy: Current status and relevance

Area of Science:

• Medical Science
• Dermatology
• Neurology

Background:

• Pure neuritic leprosy (PNL) is a distinct leprosy subgroup with diagnostic and management challenges.
• It is globally relevant, particularly in India, and often presents with severe disability due to early nerve involvement.
• Sub-clinical skin involvement and progression to manifest cutaneous disease occur in a significant proportion of PNL cases.

Purpose of the Study:

• To highlight the diagnostic ambiguities and management strategies for pure neuritic leprosy.
• To emphasize the role of high-resolution ultrasonography (HRUS) in objective diagnosis.
• To underscore the importance of comprehensive management for preventing disability.

Main Methods:

• Review of clinical presentations and diagnostic challenges of PNL.
• Discussion of diagnostic advancements, including skin biopsies and HRUS for nerve imaging.
• Outline of current management protocols including multidrug therapy, corticosteroids, and supportive care.

Main Results:

• PNL diagnosis has historically been subjective, but HRUS offers objective nerve thickening and morphological assessment.
• Skin biopsies can reveal leprosy pathology in PNL, indicating sub-clinical involvement.
• Up to 20% of PNL cases may develop overt skin lesions during follow-up.

Conclusions:

• Pure neuritic leprosy requires specific recognition and management strategies.
• HRUS is a valuable tool for objective diagnosis and monitoring of nerve changes in PNL.
• Multidrug therapy combined with corticosteroids and supportive care is crucial for managing PNL and preventing disability.