AnnexIII DifferentialDiagnosis FromNLEP India PDF

Annexure –III
Differential Diagnosis for leprosy

Differential Diagnosis of Flat Lesion
BIRTH MARK OR NAEVUS VITILIGO CONTACT DERMATITIS
 Present since birth.

 Edges sharply defined saw
 Depigmented lesion
tooth appearance
 Sweating normal.  Itching common.
 Normal sweating.  Sensations intact.
 Sensations intact.
 Sensations intact.  On exposed-contacting part
 White hairs on lesion.
 Triple response normal  History of acute oozing phase
 Along line of Blaschko
LICHENOID DERMATITIS TINEA VERSICOLOR SEBORRHOEIC DERMATITIS
 Sensation normal  Sensations normal.  Sensations normal.

 Patch itchy  Patches have variable mild  Sever itching on patches.
 Hypo-pigmented to itchy ness  Scalp commonly involved.
violaceous  Seasonal.  Oily yellowish scales
 Small lesions coalescing  Fungus can be demonstrated.
 Start around hair follicle
opening
 In seborrhoeic sites
SCAR TISSUE
 History of injury/trauma
 Sensations may or may not be
present
xi
Differential Diagnosis of Raised Lesions
GRANULOMA ANNULARE GRANULOMA RING-WORM
MULTIFORME
 Sensations normal.
 Annular (ring shaped orientation)  Scaly appearance at periphery if
in extremities  Large –dramatic geographic
patches untreated
 No sensory impairment or nerve  Itchy patches.
changes  without skin sensory
changes  Superficial look.
 History/family H/o Diabetes  Fungus can be demonstrated (if
 nerve involvement absent
untreated)
LYMPHOMA LUPUS VULGARIS (Skin PSORIASIS

TB)
 Silvery- Scaly lesions on extensor

surface
 Sensations usually normal  Sensations normal
 Sensations normal  Lymph node involvement  On scraping leaves bleeding points
 Long standing lesion  Area of healing with scar (Auspitz sign)
 Associated lymphadenopathy  Area of activity  Increases during winter/ summer
hepato- splenomegaly erythematous (seasonality)
 Nerves normal  Joint involvement may be present
Differential Diagnosis of Nodular Lesions
NEUROFIBROMATOSIS DERMAL XANTHOMATOSIS

LEISHMANIASIS
 Coffee-ground coloured macules  Skin coloured to yellow nodules

 Nodules/ infiltration on face papules plaques on tuberosities (bony
 Soft multiple nodules, painful on on even ear like LL
pressure (sometimes) prominences)
 History of kala-azar.  Uncommon condition
 Skin smears negative for M.  Skin smears negative for M.
leprae.  Skin smears negative for M. leprae.
leprae.  Blood cholesterol level high.
 Iris lesions (Refer to eye specialist  No sensory changes
 Familial  No nerve lesion
 No nerve abnormalities
 Present since birth/early childhood
xii
Differential Diagnosis of Neurological Conditions
DIFFERENTIAL DIAGNOSES OF NEUROLOGICAL CONDITIONS:

1. Post infectious (viral)
2. Diabetic Neurophathy
3. Alcoholic Neuropathy
4. Syringomyelia
5. Tabes-dorsalis
POST INFECTIONS (VIRAL) Sensory/motor peripheral neuropathy.

1. Acute/sub-acute onset
2. Correlation (temporal) with recovery from viral illness
3. Neuritic symptoms heralds onset, may quieter later
4. Variable sensor/motor loss-different from leprosy
5. No nerve thickening/skin patch
DIABETIC NEUROPHATHY
1. Distal bilateral neuropathy.
2. ‘Glove & stocking’ type of anaesthesia.
3. ‘Burning feet’ syndrome.
4. Knee and ankle reflexes lost.
5. High blood sugar level.
6. Peripheral nerves normal
ALCOHOLIC NEUROPATHY
1. Patient has alcoholic history
2. Face that of an alcoholic
3. Red-angry tongue
4. Cheilitis present. (Inflammation of the lips)
SYRINGOMYELIA
1. Uncommon condition
2. Disease of CNS
3. Cause unknown
4. Heat and pain sensation lost
5. Touch sensation present
6. Peripheral nerves not enlarged
TABES - DORSALIS
1. A variety of neurosyphilis.
2. Intense, recurring lightening pain in legs.
3. Stamping type of gait.
4. Romberg's sign positive
(Inability to stand erect with eyes closed & feet together)
5. Knee reflexes absent.
6. Common Peroneal nerve normal
xiii

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Annexure –III

Differential Diagnosis for leprosy

BIRTH MARK OR NAEVUS VITILIGO CONTACT DERMATITIS

 Present since birth.

LICHENOID DERMATITIS TINEA VERSICOLOR SEBORRHOEIC DERMATITIS

 Sensation normal  Sensations normal.  Sensations normal.

LYMPHOMA LUPUS VULGARIS (Skin PSORIASIS

 Silvery- Scaly lesions on extensor

Differential Diagnosis of Nodular Lesions

NEUROFIBROMATOSIS DERMAL XANTHOMATOSIS

 Coffee-ground coloured macules  Skin coloured to yellow nodules

DIFFERENTIAL DIAGNOSES OF NEUROLOGICAL CONDITIONS:

POST INFECTIONS (VIRAL) Sensory/motor peripheral neuropathy.

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