A Mimicker of Tinea Faciei

Dr. Rathish T. Pillai

MD

Head of Department

Department of Dermatology

Azeezia Medical College, Kollam, Kerala

Dr. Shahnaz A. S.

Junior Resident

Department of Dermatology

Azeezia Medical College, Kollam, Kerala

Dr. Sana Shams

Junior Resident

Department of Dermatology

Azeezia Medical College, Kollam, Kerala

Introduction

Leprosy, also known as Hansen’s disease, is a chronic granulomatous disease caused by the bacteria Mycobacterium leprae. It primarily affects the peripheral nerves and skin. According to the World Health Organization (WHO), individuals having one of the following three features have leprosy: (i) definite loss of sensation in a pale (hypopigmented) or reddish skin patch; (ii) a thickened or enlarged peripheral nerve with loss of sensation; and (iii) the presence of acid-fast bacilli in a slit-skin smear.(1) Clinically this neglected tropical infectious condition has a variable clinical presentation in reference to the patient's immune status. The Ridley and Jopling/WHO classification criteria, is based totally on; scientifically clinical symptoms, pathological, bacilloscopic, and immunological components of the disorder, thus, allowing for a radical characterization or instead categorization of six leprosy class: the polar tuberculoid leprosy (TT), borderline tuberculoid (BT), the intermediate borderlineborderline (BB), borderline lepromatous 6 (BL) and lepromatous leprosy (LL) form.(2)

The goal of the WHO and CDC is to completely eradicate leprosy. Eradication efforts have included free treatment, close monitoring, and education of family members.(3)

Case Description

A 56 year old female presented to the Department of Dermatology due to erythematous annular skin lesion over the left side of face since 3 months. She had no history of pruritus. She consulted a general practitioner for the same and was diagnosed with tinea faciei and was prescribed systemic and topical antifungals. The patient took the treatment for 2 months with no improvement. Since there was no improvement and the lesion became more severe she presented to the Department of Dermatology. On examination, a single well defined erythematous plaque with raised margin and central clearing about 7cmx5cm size was observed on the left side of face. Sensations were decreased over the lesion.

Skin biopsy was taken in view of suspicion of hansen’s disease, which revealed hansen’s disease- borderline tuberculoid type. The patient along with family members were educated about the risk of transmission and the associated signs and symptoms of the condition. The patient was referred to the nearest leprosy center to start MDT.

Discussion

Leprosy is one of the oldest diseases known to man. Despite advances in all spheres of medical science, leprosy continues to be a public health challenge in countries like India.(4) Leprosy is the great imitator, therefore Dermatologists should always consider leprosy as a differential diagnosis in suspicious cases. A histopathological examination can help to differentiate leprosy skin lesions from skin lesions of other diseases.

References

1. Shiva Raj KC, Geetika KC, Gyawali P, Singh M, Sijapati MJ. LeprosyEliminated and forgotten: A case report. Journal of Medical Case Reports. 2019 Sep 1;13(1).

2. Malumani M, Malan M, Kaseya COR, Quan SJ. NF-KB Single Nucleotide Polymorphism View project Hansen’s Disease: A Neglected Tropical Infectious Condition 1 2 *3 [Internet]. Available from: https://www.researchgate.net/ publication/338455925

3. Luchtefeld W. Clinical Case Report

[Internet]. Vol. 38, The Nurse Practitioner •. 2013. Available from: www.tnpj.com

4. RaoPn, Suneetha S. Current situation of leprosy in India and its future implications. Indian Dermatology Online Journal. 2018;9(2):83.