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Cutaneous nerves in leprosy; the relationship between histopathology and cutaneous sensibility



Cutaneous nerves in leprosy; the relationship between histopathology and cutaneous sensibility



Brain 78(4): 615-633



The sensory acuity (touch, warmth and pain) of 232 areas of skin in leprous patients was determined. The neurohistological picture in whole mounts of skin from these areas was then examined after vitally staining with methylene-blue. Both sets of observations were then correlated. The patients were classified as 69 "neural", 87 "lepromatous" and 76 "normal" areas of skin were examined. In nearly all the "neural" and more than half the "lepromatous" cases there was loss or impairment of pain and/or warmth sensibility. In two-thrids of the "neural" but in only one-twelfth of "lepromatous" cases, was there concomitant loss or impairment of touch sensibility. Warmth and pain sensibility were usually affected concurrently and in early lesions, touch being affected in older and more severe lesions. The density of inneravation was greatest in "normal" skin, rather less dense in skin from "lepromatous" lesions and least dense in skin from "neural" lesions. Macules either neural or lepromatous, contained fewer damaged nerve fibers than the other types of lesion. The correlation between sensory testing and nerve damage was generally good although sensory impairment was not apparent in some "lepromatous" cases which exhibited considerable nerve damage. No encapsulated nerve endings were seen in any of the areas of skin examined. Since they were all taken from "hairy" zones it is reasonable to assume that such endings do not normally occur in hairy skin in man. All nerves which could be traced towards their termination apparently ended freely. This applied to those ending in the dermis and in relation to blood vessels as well as those related to hairs, the so-called "tricho-neural apparatus". These observations indicate that the inter-follicular free nerve endings subserve warmth as well as pain sensibility. The fact that touch was only affected in the more severe forms of lesion is explained on the basis that the hairs lie in a deeper plane and that the disease spreads cen-tripetally.

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Accession: 024426998

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PMID: 13293272


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