Patients With Erythema Nodosum Leprosum Lack T-Suppressor Cells

To the Editor.—  In the February issue of the Archives, Modlin et al¹ reported the results of their skin and blood studies of T-lymphocyte subpopulations in erythema nodosum leprosum (ENL). They found that the dermal infiltrates of ENL had more numerous cells of the helper-inducer phenotype and fewer of the suppressor-cytotoxic phenotype, as compared with non-ENL lepromatous tissue. By contrast, T-cell studies in the blood of patients with ENL did not show significant abnormalities. Interestingly, the blood helper-suppressor (HS) ratio was the same, ie, 1.7 (normal value), in patients with and without ENL, although this ratio was clearly different in skin studies— patients with ENL had fewer suppressor cells (HS ratio, 2.1 ± 0.4) than non-ENL lepromatous patients (HS ratio, 0.6 ± 0.4).In their article, Modlin et al stated that the blood values they found in patients with ENL were different from those reported by two other groups,