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When leprosy is considered in the differential diagnosis of cutaneous disease, it is all too frequently excluded on the basis of such statements as "examination of the nasal discharges failed to show lepra bacilli" or "the lesions were not anesthetic to light touch" or, worse still, "to pinprick."
It should be more widely realized that such observations as these do not exclude leprosy at all; indeed, they do not cast the slightest shadow of improbability on that diagnosis.
The principal diagnostic criteria for early leprosy are as follows: (1) almost any sort of cutaneous lesion—or, not infrequently, no lesion of the skin at all; (2) thermal anesthesia, frequently found in a cutaneous lesion but perhaps of even more significance when found in normal-looking skin (it is only occasionally associated with anesthesia to light touch and then usually in a small area roughly concentric with the thermally anesthetic zone); (3) muscular
Arnold HL. DIFFERENTIAL DIAGNOSIS IN LEPROSY. Arch Derm Syphilol. 1941;44(5):911–912. doi:10.1001/archderm.1941.01500050141014
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