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LETTERS TO THE EDITOR - LETTER IN RESPONSE TO PREVIOUSLY PUBLISHED ARTICLES
Year : 2019  |  Volume : 85  |  Issue : 3  |  Page : 314-315

Authors' reply


1 Department of Dermatology, Baroda Medical College, Vadodara, Gujarat, India
2 Department of Dermatology, Government Medical College and Hospital, Haldwani, Uttarakhand, India
3 Department of Dermatology, Katihar Medical College, Katihar, Bihar, India

Date of Web Publication19-Apr-2019

Correspondence Address:
Dr. Piyush Kumar
Department of Dermatology, Katihar Medical College, Katihar, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdvl.IJDVL_192_19

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How to cite this article:
Shah H, Tiwary AK, Kumar P. Authors' reply. Indian J Dermatol Venereol Leprol 2019;85:314-5

How to cite this URL:
Shah H, Tiwary AK, Kumar P. Authors' reply. Indian J Dermatol Venereol Leprol [serial online] 2019 [cited 2019 Sep 17];85:314-5. Available from: http://www.ijdvl.com/text.asp?2019/85/3/314/255284




Sir,

We thank the author for taking interest in our article and raising the issue of potential role of transepidermal elimination of live lepra bacilli in transmission of the disease. We completely agree with the views and concern of the correspondent in connection with the significance of transepidermal elimination in cutaneous spread of leprosy in histoid and lepromatous cases. One of the authors (PK) has recently observed a lepromatous leprosy case with molluscoid (or umbilicated) papules and transepidermal elimination of lepra bacilli (unpublished observation). The publications on transepidermal elimination of lepra bacilli are scarce.[1],[2],[3] However, considering the load of lepromatous cases in an endemic country like India, the authors believe it to be an underobserved and underreported phenomenon. The significance of transepidermal elimination of lepra bacilli is not clear, but the authors have speculated that it might play a role in cutaneous transmission of leprosy. The implications of “probable cutaneous transmission” are profound; household contacts, leprosy researchers, and leprosy control program need to be notified.

Although the role of basal keratinocytes, Langerhans cells and T cells has been suggested in transmission of lepra bacilli from the upper dermis to different epidermal layers, precise mechanism of this phenomenon in leprosy is not yet clear.[2],[4] Therefore, we have kept the example of histoid leprosy under “other and unspecified conditions” in [Table 1]. We do concur that further studies with substantial evidence are much needed to unravel this event considering the global burden of leprosy and challenges in its elimination.[1],[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghorpade AK. Transepidermal elimination of Mycobacterium leprae in histoid leprosy: A case report suggesting possible participation of skin in leprosy transmission. Indian J Dermatol Venereol Leprol 2011;77:59-61.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Fischer MK, Myer KA, Que SK, Harris JA, Martiniuk FT, Meehan SA, et al. Pseudoepitheliomatous hyperplasia and transepidermal elimination in lepromatous leprosy: Does T-cell plasticity play a role? J Drugs Dermatol 2012;11:1232-5.  Back to cited text no. 2
    
3.
Ghorpade A. Histoid leprosy with mycobacterial keratinous bullets after possible transepidermal elimination of bacilli. Int J Dermatol 2013;52:1530-2.  Back to cited text no. 3
    
4.
Namisato M, Kakuta M, Kawatsu K, Obara A, Izumi S, Ogawa H. Transepidermal elimination of lepromatous granuloma: A mechanism for mass transport of viable bacilli. Lepr Rev 1997;68:167-72.  Back to cited text no. 4
    




 

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