The diagnosis of advanced leprosy presents no difficulty; the organisms are found readily, and the characteristic histologic changes are present in some lesions. Bizarre manifestations are occasionally seen but usually do not obscure the typical clinical picture. However, when such manifestations assume a major role and no classic signs are present, the clinician is apt to be misled. Such an instance was Pardo-Castello's case of dermatitis atrophicans diffusa et progressiva,1 which could easily have been passed as having no connection with leprosy by clinicians less astute in the diagnosis than he.
The disease may begin in an unusual manner, develop insidiously and parade for some time unrecognized. Ayres 2 reported a case with such a background before the Los Angeles Dermatological Society in 1935. His patient showed a thinning of the right eyebrow, diffuse flushing of the face and tissue-paper-like atrophy of the skin of the hands, the arms, the
LEHMANN CF. LEPROSY: A REVIEW OF SOME OF ITS UNUSUAL FEATURES. Arch Derm Syphilol. 1938;37(2):175–195. doi:10.1001/archderm.1938.01480080008002
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