Vasculonecrotic reactions in leprosy

Abstract

Multibacillary, lepromatous or borderline leprosy patients may present two types of vasculonecrotic reactions: Lucio phenomenon and that associated with erythema nodosum leprosum. Despite they can be distinguished through clinical and histological characteristics; both are often used as synonyms. It is said that leprosy reaction should be properly classified for therapeutic reasons, since it is well known that in Lucio phenomenon there is not a good response to thalidomide. The authors reported two cases of vasculonecrotic phenomena in lepromatous leprosy sharing clinical and histopathological characteristics of both reaction subtypes. The findings may indicate the spectral nature of the reaction phenomena in leprosy and emphasize the importance of the clinic-pathological correlation for proper classification. Our findings may contribute to the understanding of leprosy reactions pathogenesis, broaden the knowledge about their outcome with standard treatment, and provide the scientific background to design better therapeutic strategies for these complications.

Is it lucio phenomenon or necrotic erythema nodosum leprosum?

“…[8] The ulcers heal with fibrotic scars. [3] Even though there have been various reports in the past of EN with necrosis occurringin untreated cases of multibacillary leprosy,[9–11] they were allassociated with fever and constitutional symptoms, which was conspicuously absent in our case.…”

Lepra Reaction with Lucio Phenomenon Mimicking Cutaneous Vasculitis

“…What was odd in our patient for Lucio phenomenon was the onset of skin infarcts 4 months after starting antileprotic therapy. Lucio phenomenon is usually the presenting feature that heralds a diagnosis of leprosy [ 8 , 12 ]. Also, the presence of cutaneous infarcts in the absence of blistering or ulcerating lesions is distinctly unusual for Lucio phenomenon (Magaña et al reported a similar finding in only 3 out of 12 patients with Lucio phenomenon) [ 8 ].…”

Classification of vascular disorders in the skin and selected data on new evaluation and treatment

“…Erythema nodosum leprosum is more frequent in the first months of treatment in patients with nodules and plaques. Patients with Lucio's phenomenon do not respond well to thalidomide in contrast to erythema nodosum leprosum (45).…”