Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study.

BACKGROUND: Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients' hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs. CONCLUSION: IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.

Thermographic analysis and autonomic response in the hands of patients with leprosy.

BACKGROUND: Low temperatures and slow blood flow may result from peripheral neuropathy caused by leprosy, and the simple detection of cold fingers could already be a preliminary classification for these patients. OBJECTIVE: To investigate whether infrared thermography would be able to measure this change in temperature in the hands of people with leprosy. METHOD: The study assessed 17 leprosy patients who were under treatment at the National Reference Center for Sanitary Dermatology and Leprosy, Uberlândia/MG, and 15 people without leprosy for the control group. The infrared camera FLIR A325 and Therma CAM Researcher Professional 2.9 software were used to measure the temperature. The room was air-conditioned, maintaining the temperature at 25°C; the distance between the camera and the limb was 70 cm. The vasomotor reflex of patients was tested by a cold stress on the palm. RESULTS: The study showed a significant interaction between the clinical form of leprosy and temperature, where the control group and the borderline-borderline form revealed a higher initial temperature, while borderline-lepromatous and lepromatous leprosy showed a lower temperature. Regarding vasomotor reflex, lepromatous leprosy patients were unable to recover the initial temperature after cold stress, while those with the borderline-tuberculoid form not only recovered but exceeded the initial temperature. CONCLUSION: Thermography proved a potential tool to assist in the early detection of neuropathies, helping in the prevention of major nerve damage and the installation of deformities and disabilities that are characteristic of leprosy.

Thermographic analysis and autonomic response in the hands of patients with leprosy

Abstract: Background: Low temperatures and slow blood flow may result from peripheral neuropathy caused by leprosy, and the simple detection of cold fingers could already be a preliminary classification for these patients. Objective: To investigate whether infrared thermography would be able to measure this change in temperature in the hands of people with leprosy. Method: The study assessed 17 leprosy patients who were under treatment at the National Reference Center for Sanitary Dermatology and Leprosy, Uberlândia/MG, and 15 people without leprosy for the control group. The infrared camera FLIR A325 and Therma CAM Researcher Professional 2.9 software were used to measure the temperature. The room was air-conditioned, maintaining the temperature at 25°C; the distance between the camera and the limb was 70 cm. The vasomotor reflex of patients was tested by a cold stress on the palm. Results: The study showed a significant interaction between the clinical form of leprosy and temperature, where the control group and the borderline-borderline form revealed a higher initial temperature, while borderline-lepromatous and lepromatous leprosy showed a lower temperature. Regarding vasomotor reflex, lepromatous leprosy patients were unable to recover the initial temperature after cold stress, while those with the borderline-tuberculoid form not only recovered but exceeded the initial temperature. Conclusion: Thermography proved a potential tool to assist in the early detection of neuropathies, helping in the prevention of major nerve damage and the installation of deformities and disabilities that are characteristic of leprosy.

¿Lepra o Morfea? / No disponible

Estudiamos un niño de tres años de edad con una placa dorsal que había comenzado dos años antes como un nódulo discreto, que se interpretó como un tumor benigno. La lesión aumentó de tamaño en los últimos seis meses y se convirtió en una placa firme, infiltrada, dolorosa a la presión profunda. Se interpretó clínicamente como morfea. La biopsia de piel, de 10 x 4 x 3 mm, mostró esclerosis dérmica e inflamación linfohistiocitaria importante sin granulomas, más notoria en el límite dermohipodérmico, con notorio infiltrado perineural, de difícil diferenciación con lepra indeterminada o dimorfa lepromatosa. Los cortes seriados, la correlación clínico patológica, la ausencia de daño neural notorio en los nervios situados en el centro de la inflamación, la negatividad del Ziehl-Neelsen y la esclerosis dérmica permitieron concluir que el niño tenía morfea. Esta entidad es un diagnóstico diferencial importante clínico de lepra tuberculoide e histológico, de lepra indeterminada. Una biopsia amplia (10 x 5 x 7 mm), con hipodermis, facilita establecer la diferencia por la presencia de esclerosis, propia de la morfea y no de la lepra, por la ausencia de daño intra y perineural en la morfea, en los filetes nerviosos situados dentro del proceso inflamatorio, daño que es muy notorio en la lepra (AU)

No disponible

Thermography of the nose and ear in relation to the skin lesions of lepromatous leprosy, tuberculosis, leishmaniasis, and lupus pernio.

The nasal and aural temperature patterns of 100 normal subjects have been investigated by infrared thermography, paying particular attention to possible errors of instrumentation and technique which may arise in such areas of complex morphology. Although by no means invariable, the pattern of themograms confirms that certain areas which are relatively cool are often affected in lepromatous leprosy, tuberculosis, leishmaniasis, and lupus pernio. In lepromatous leprosy, low temperature appears to govern the localization of disease in most parts of the body, and the possible reasons for this are discussed. Thermography may have a place in the investigation of other skin diseases in which the distribution of lesions on the body surface is unexplained.