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Year : 1994  |  Volume : 60  |  Issue : 1  |  Page : 41-42

Tuberculoid leprosy involving hairy scalp:A case report

Correspondence Address:
Ashok Ghorpade

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Tuebrculoid leprosy involving the hairy scalp is described. The lesion was single, raised, involved the hairy area of scalp and extended to the surrounding non hairy area also. It is interesting to note that scalp, which is presumed to be immune to leprosy, was singled out by the Mycobacterium leprae, leaving other cooler areas free. To the best of our knowledge such a preferential scalp affliction has not been reported earlier in literature.

Keywords: Leprosy, Tuberculoid leprosy, Hairy scalp

How to cite this article:
Ghorpade A, Ramanan C, Manglani P. Tuberculoid leprosy involving hairy scalp:A case report. Indian J Dermatol Venereol Leprol 1994;60:41-2

How to cite this URL:
Ghorpade A, Ramanan C, Manglani P. Tuberculoid leprosy involving hairy scalp:A case report. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2020 Dec 3];60:41-2. Available from:

  Introduction Top

Mycobacterium leprae, which has a predilection for the cooler areas of body, is usually known to spare scalp especially hairy scalp, because of its higher temperature. Scalp is therefore considered to be immune to leprosy. The rare cases of scalp involvement reported were mostly in multibacillary leprosy. We had earlier reported tuberculoid leprosy involving the hairy scalp. [1] In the case mentioned here, the lesion was singularly involving the hairy scalp, the so called "immune zone" for leprosy.

  Case Report Top

A 20-year-old Hindu male, resident of Bhilai consulted us for a hypopigmented patch on the nape of the neck behind left ear which was noticed by his sister about 10 days earlier.The exact duration of the lesion could not be ascertained, since it was asymptomatic and the patient was not aware of it. There was no family history of similar problem.

Cutaneous examination showed single, well defined, hypopigmented, dry, anaesthetic, slightly raised, pear shaped plaque about 4.5 cm in length on the hairy occipital area of scalp extending on to the non-hairy skin on nape of the neck. There was infiltration at the periphery [Figure 1]. Nearly half of the plaque was inside the hair line with sparse hairs in that part. There was no other skin lesion or nerve thickening. Systemic examination was not contributory. Histopathology from the lesion revealed multiple, well-defined granulomas of lymphocytes and epitheloid cells and few Langhan's giant cells in the upper dermis. There was no epidermal erosion and the tissue did not show any acid fast bacilli.

The patient showed remarkable improvement after 9 months of treatment with dapsone 100 mg daily and rifampicin 600 mg monthly (supervised).

  Comments Top

Hairy scalp is the warmest area of the skin. [2] The scanty reports of scalp involvement in leprosy have been mostly on the bald areas of scalp. This has been explained to be due to the lower temperature of bald scalp as compared to the hairy scalp. [3] Few cases of leprosy in whom scalp was found to be involved belonged to the multibacillary group only. [4],[5] A case of borderline tuberculoid leprosy on regularly shaved scalp has also been mentioned . [6] sub We were the first to describe a raised plaque of tuberculoid leprosy involving the hairy occipital area of scalp. [1]

According to Jopling and McDougall [2], plaques and nodules are not found on the hairy scalp in leprosy. The presence of a well defined, raised plaque in the present case and the earlier one, reported by us indicates that it may not always be true.

Moreover, all the cases described so far, mostly had lesions on other parts of the body also, in addition to the scalp lesions. In the case reported here, the single plaque of tuberculoid leprosy was prominent on the hairy scalp and there were no lesions elsewhere. The lesion had probably started on the hairy scalp and then spread onto the adjoining area of neck, after which it was noticed. It is intriguing why the Myco­bacterium leprae, which has a predilection for cooler parts of the body opted for the warmer area in the present case.

  References Top

1.Ghorpade A, Ramanan C, Manglani PR Tuberculoid leprosy on hairy scalp - a case report. Lepr Rev 1988; 59 : 235-7.  Back to cited text no. 1    
2.Jopling WH, Mc Dougall AC. The disease In : Handbook of Leprosy, 4 Heinemann; 1988; 24.  Back to cited text no. 2    
3.Dutta AK, Mandal SB, Jopling VVH. Surface temperature of bald and hairy scalp I, reference to leprosy affection. Indian Dermatol 1983; 28 : 1-5.  Back to cited text no. 3    
4.Faget GH. Alopecia leprosa in the United states. Int J Lepr 1946; 14 : 42.  Back to cited text no. 4    
5.Malviya GN, Girdhar BK, Husain S, Ramu G, Lavania RK, Desikan KV. Scalp lesion in a lepromatous patient. Lepr India 1987; 59: 103-5.  Back to cited text no. 5    
6.Parikh DA, Oberai C, Ganpati P. Involvement of scalp in leprosy. Lepr India 1985; 57: 883-6.  Back to cited text no. 6    

This article has been cited by
1 Immune zones in leprosy
Rajashekar, T.S., Singh, G., Naik, L.C.
Indian Journal of Dermatology. 2009; 54(3): 206-210


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