A descriptive study of non-neuropathic ulcers in leprosy: a retrospective study in a tertiary hospital in India

Background Cutaneous ulcers sometimes cause diagnostic confusion, whether they are due to disease, reactions or neuropathy. The present study aims to study the non-neuropathic cutaneous ulcers in leprosy. Methods Retrospective data from 2015 to 2023 were analyzed. Details were recorded in a pre-designed proforma. Results A total of 21 cases with non-neuropathic ulcers were recruited. The mean age was 46 years with a male predominance: 17 (81%). Most of the patients had lepromatous leprosy (LL) 13 (62%). A majority, 18 (86%) suffered from disability. The most common sites of ulceration were the arms and legs: 17 (81%). The most common presentation was crusted nodular-plaque lesions in 12 (56%) patients, followed by erosions over plaques in 4 (19%), ulcers with sloping margins in 2 (10%), punched out ulcers, ulceration in an annular configuration and jagged ulcers in 1 (5%) patient each. ENL was the most common cause of non-neuropathic cutaneous ulceration, clinically suspected in 17 patients (81%) and proven on histopathology in 14 (67%) patients. Chronic and recurrent ENL constituted (8/17 patients, 47%) almost half of the ENL cases. Spontaneous ulceration without any evidence of reaction was noted in 4 patients, BT leprosy in 1 (5%) patient and BL leprosy in 3 (14%) patients. Conclusion Most of the patients with non-neuropathic ulcers had LL or BL leprosy, and nearly eighty-five percent suffered from disability. ENL was the most common cause of non-neuropathic cutaneous ulceration, out of which chronic and recurrent ENL constituted half of cases. Spontaneous ulceration without any evidence of reaction was noted in only a few patients.