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Leprosy classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]Kiran Singh, M.D. [3]

Overview

Overview

The Ridley Jopling classification and the WHO classification are the two most widely used systems to classify Leprosy. These classification systems are based on clinical, microbiologic and histopathological features, and are used to determine the patient’s prognosis and the treatment regimen.[1][2][3]

Classification

Classification

There are different systems for classifying leprosy. However, the two more common classification schemes include the WHO and the Ridley-Jopling systems.

WHO Ridley-Jopling ICD-10 MeSH Description Lepromin test Immune target
Paucibacillary Tuberculoid (“TT”), Borderline Tuberculoid (“BT”) A30.1, A30.2 Tuberculoid It is characterized by one or more hypopigmented skin macules and anaesthetic patches, where skin sensations are lost because of damaged peripheral nerves that have been attacked by the host’s immune cells. Positive Bacillus (Th1)
Multibacillary Midborderline or Borderline (“BB”) A30.3 Borderline Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become lepromatous, or may undergo a reversal reaction, becoming more like the tuberculoid form.
Multibacillary Borderline Lepromatous (“BL”), and Lepromatous (“LL”) A30.4, A30.5 Lepromatous It is associated with symmetric skin lesions, nodules, plaques, thickened dermis and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis but detectable nerve damage is late. Negative Plasmid inside Bacillus (Th2)
Ridley Jopling Classification

Ridley Jopling Classification

There are 6 classes in the Ridley Jopling classification scheme. This classification is based on the following:[4]

Tuberculoid or Paucibacillary Pole

This is the least severe form of the disease. In this form of the disease the following are present:

Skin

Ear
Trunk
Extremity
Genitalia
Gluteal Region
Nodular leprosy of childhood
Face
Trunk

Lepromatous or Multi-Bacillary Pole

In this form of the disease the following are present:

Skin

Face
Trunk
Extremity
Ear

Image:Lepromatous leprosy09.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy18.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy23.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy27.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy28.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy35.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy36.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy40.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] Image:Lepromatous leprosy83.jpg|Lepromatous leprosy. Adapted from Dermatology Atlas.[5] </gallery>

Intermediate, Dimorphous or Borderline State

This last category is divided into 3 subcategories:

Borderline Tuberculoid, or BT

In this form of the disease the following are present:

Mid-Borderline, Borderline-Borderline, or BB

This is considered to be where the disease usually begins, progressing towards one of the poles afterwards.[1]

Borderline Lepromatous, or BL

In this form of the disease the following are present:

Indeterminate

In this form of the disease the following are present:

  • Early unspecific lesions
  • Nerve infiltrates, lacking required criteria for being classified as above mentioned
  • Used only when there is diagnostic proof of leprosy, from a biopsy sample, with evidence of mycobacterium leprae and perineural infiltrates but the disease is not advanced enough to show the clear patient position in the leprosy classification.

Skin

Extremity
Trunk

WHO classification

The WHO organization classification scheme is simpler, and it is based upon the number of skin lesions. This simpler classification scheme can be applied in the absence of laboratory support or clinical expertise. It allows a rapid diagnosis, selection and initiation of treatment. The leprosy subtypes include:[6][4]

Paucibacillary or PB

Multibacillary or MB

If a skin smear is done and shows a positive result, then that patient will immediately be classified as multibacillary, irrespective of the number of skin lesions identified on physical examination. Despite its ease of use, this classification scheme may unfortunately mis-classify some patients resulting in under treatment of those cases.

References

  1. ↑ 1.0 1.1 Walker, Stephen L.; Lockwood, Dina N.J. (2007). “Leprosy”. Clinics in Dermatology. 25 (2): 165–172. doi:10.1016/j.clindermatol.2006.05.012. ISSN 0738-081X.
  2. ↑ Eichelmann, K.; González González, S.E.; Salas-Alanis, J.C.; Ocampo-Candiani, J. (2013). “Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment”. Actas Dermo-Sifiliográficas (English Edition). 104 (7): 554–563. doi:10.1016/j.adengl.2012.03.028. ISSN 1578-2190.
  3. ↑ Bhat, Ramesh Marne; Prakash, Chaitra (2012). “Leprosy: An Overview of Pathophysiology”. Interdisciplinary Perspectives on Infectious Diseases. 2012: 1–6. doi:10.1155/2012/181089. ISSN 1687-708X.
  4. ↑ 4.0 4.1 Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH (2007). “Methods for the classification of leprosy for treatment purposes”. Clin Infect Dis. 44 (8): 1096–9. doi:10.1086/512809. PMID 17366457.
  5. ↑ 5.000 5.001 5.002 5.003 5.004 5.005 5.006 5.007 5.008 5.009 5.010 5.011 5.012 5.013 5.014 5.015 5.016 5.017 5.018 5.019 5.020 5.021 5.022 5.023 5.024 5.025 5.026 5.027 5.028 5.029 5.030 5.031 5.032 5.033 5.034 5.035 5.036 5.037 5.038 5.039 5.040 5.041 5.042 5.043 5.044 5.045 5.046 5.047 5.048 5.049 5.050 5.051 5.052 5.053 5.054 5.055 5.056 5.057 5.058 5.059 5.060 5.061 5.062 5.063 5.064 5.065 5.066 5.067 5.068 5.069 5.070 5.071 5.072 5.073 5.074 5.075 5.076 5.077 5.078 5.079 5.080 5.081 5.082 5.083 5.084 5.085 5.086 5.087 5.088 5.089 5.090 5.091 5.092 5.093 5.094 5.095 5.096 5.097 5.098 5.099 5.100 5.101 5.102 5.103 5.104 5.105 5.106 5.107 5.108 5.109 5.110 5.111 5.112 5.113 5.114 5.115 5.116 5.117 5.118 5.119 5.120 5.121 5.122 5.123 5.124 5.125 5.126 5.127 5.128 5.129 5.130 5.131 5.132 5.133 5.134 5.135 5.136 5.137 5.138 5.139 5.140 5.141 5.142 5.143 5.144 5.145 5.146 5.147 5.148 5.149 5.150 5.151 5.152 5.153 5.154 5.155 5.156 5.157 5.158 5.159 5.160 5.161 5.162 5.163 5.164 5.165 5.166 5.167 5.168 5.169 5.170 5.171 5.172 5.173 5.174 5.175 5.176 5.177 5.178 5.179 5.180 5.181 5.182 5.183 “Dermatology Atlas”.
  6. ↑ “Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)” (PDF).


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