Lupus can also affect the skin and cause a rash or other kinds of skin changes. May have a characteristic bulls-eye appearance. Nummular eczema should be differentiated from tinea corporis and psoriasis. Normally, blood clots form when there is an injury to prevent the body from bleeding too much. Erythema and Urticaria. Wear a wide-brimmed hat (preferably one with SPF protection), tightly woven clothes, long sleeves and large sunglasses when outdoors. SCLE is characterized by the rapid appearance of small or large, erythematous to pink-colored plaques with raised borders, central clearing, and an easily detached scale.41,42 The eruption is extremely photosensitive and, thus, most commonly will present on the face, upper trunk, and the backs of the arms.41, In differentiating SCLE from other annular lesions, a history of sun exposure in correlation with the appropriate distribution supports the diagnosis. This patient developed a lupus rash after spending time under fluorescent lighting. Most eruptions spontaneously resolve in two to eight weeks.28 Treatment with anthelmintics can shorten the course of the disease. Ringworm . In: James WD, Berger TG, Elston DM. ENT. The patches are thick, raised, and scaly, says Stojan. Favor the face, neck, and areas of trauma. If pruritus is present or treatment is desired, corticosteroids often are effective, but topical applications are preferred, as recurrence upon discontinuation of systemic agents is common.14,16, Erythema chronicum migrans (ECM) is the cutaneous manifestation of Lyme disease. In naming dermatophyte infections, the term tinea is used, followed by the Latin name for the anatomical area infected.2 Subtypes include tinea corporis (body), cruris (groin), capitis (scalp), faciei (face), barbae (beard), unguium (nail), and manuum (hand). Kaushik N, Pujalte GG, Reese ST. Superficial fungal infections. What steps can I take to prevent scarring? The first kind is peritubular capillary changes, which are vascular changes in the little blood vessels around the nails," notes Stojan. In: Bolognia JL, Schaffer JV, Cerroni L. James WD, Berger TG, Elston DM. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. To diagnose EM, several lesions must evolve into the classic, target-shaped ones described above.43 In addition, EM lesions remain fixed for multiple days, whereas individual urticarial lesions last less than 24 hours. Granuloma annulare (gran-u-LOW-muh an-u-LAR-e) is a skin condition that causes a raised rash or bumps in a ring pattern. Redness and skin discoloration may take longer to go away. Large, evolving erythematous plaque without scale. Acute lupus presents with a red rash on cheeks and nose in a butterfly pattern. In: James WD, Berger TG, Elston DM. This usually starts as an. If you have symptoms, tell your dermatologist. Bites, stings, and outdoor rashes Many insects can cause a. What does a lupus rash look like on darker skin? Many types of lupus can cause hair loss. The rash typically isnt itchy or painful and rarely leaves scars. Both eczema and ringworm tend to inflame and redden the skin and can make it dry, swollen, crusty, and itchy. Asymmetric, well-demarcated, erythematous lesion with or without central clearing. In the United States, Borrelia spirochetes are transmitted to humans by an infected Ixodes tick. Annular LP is a subtype of LP present in 10% of cases and seen scattered among typical lesions described above. These other rashes dont necessarily appear in a butterfly shape. In people with subacute cutaneous lupus (SCLE), the rash looks like scaly red patches or ring shapes. Avoid going outside when the suns rays are strongest, between 10 a.m. and 4 p.m. Asymptomatic lesions with smooth, non-scaly contours are differentiated easily from the pruritic, scaly, and rough lesions of tinea. Fungus among us? Jock itch, known as tinea cruris, refers to ringworm infection of the skin around the groin, inner thighs, and buttocks. In: Bolognia JL, Schaffer JV, Cerroni L. James WD, Berger TG, Elston DM. You can expect permanent results in all but one area. Usually the rash is apparent or brought out by sun exposure. Tinea corporis is associated with a fine scale and commonly affects the trunk, unlike NE, which has a thick crust and occurs almost exclusively on the extremities. Naldi L, Gambini D. The clinical spectrum of psoriasis. Should people with lupus stop taking medications before getting their shots? Here's what to look for and how to treat it. In: Bolognia JL, Schaffer JV, Cerroni L. Perkins J, Buckland M, Miller RA. James WD, Berger TG, Elston DM. The ACLE rash is very sensitive to light. Additionally, the disease can trigger carpal tunnel syndrome, which leads to pain and numbness in the hands and fingers. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Treatment consists of potent topical corticosteroids supplemented by daily soaking and greasing with occlusive ointments.36,40 In refractory cases, phototherapy can be used.36. Scalp ringworm ( tinea capitis): This causes scaly, red, itchy bald spots on your scalp. It looks like ringworm and usually appears on the torso. In: Bolognia JL, Schaffer JV, Cerroni L. Griffiths CE, Barker JN. Annular, skin- to brown-colored plaque with a raised, ridge-like border. Let's look at why and how the process works: Lupus and medications used to treat it can affect your eyes by causing vision changes, rashes around your eyes, or inflammation in your eyes. It can look like a sunburn. ACLE rashes occur when you have a lupus flare-up. There are different types of CLE, each with different skin rashes. This is a single round or oval-shaped lesion that is 2 to 10 centimeters (cm) in diameter. In rare instances, a person with discoid lupus also develops chilblain lupus erythematosus. Other triggers include drugs (penicillin, phenytoin, allopurinol, sulfonamides, barbiturates) and Mycoplasma infections.14 Erythema multiforme can be separated into EM minor and EM major, the more severe form with mucosal involvement. Physical urticarias include dermatographic urticaria, occurring where skin has been stroked; cholinergic urticaria, occurring in response to fever and hot baths; cold urticaria, occurring on distal extremities upon rewarming; pressure urticaria, often occurring on the feet and buttocks hours after pressure has been applied; solar urticaria, occurring after exposure to light; and exercise-induced urticaria, which presents with large lesions five to 30 minutes into exercise.14, Urticaria is a clinical diagnosis based on history and physical exam. Retrieved from, What are the symptoms of lupus? What Is Lupus? Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Policy. A discoid lupus rash typically: Has circular, coin- or disk-shaped red patches that are thick and scaly. People lose hair on their scalp, legs, eyebrows, eyelashes, or elsewhere. (2013, July 12), How does lupus affect the skin? In a case of suspected Lyme disease, cutaneous findings are the most sensitive sign of early infection.18 Tick bites not associated with infection will begin to regress within a few days, while ECM will persist and progress. (2012). Lupus is a systemic autoimmune disease in which the bodys immune system attacks healthy tissues and organs. Lupus is an inflammatory disease that causes a rash to form on the body and, in an initial form, can resemble a ringworm rash. Tinea corporis is a superficial dermatophyte infection of the body, not involving the scalp, face, hands, feet, or groin.4 Classically, tinea corporis is characterized by an asymmetric, well-demarcated, erythematous, dry, and scaly patch with a raised, red advancing border.2,4 Centrally, lesions clear, forming an annular pattern.4 Individual eruptions vary in size, enlarge over time, and often are associated with mild to moderate pruritus, although smaller lesions may be asymptomatic.4, Tinea cruris, or jock itch, is dermatophytosis of the groin. Systemic lupus erythematosus can have dramatic skin involvement that comes in three variants acute, subacute, and discoid. Put up UV-protective window coverings at home and work. Connective Tissue Diseases. Treatments may include: Lupus rashes can last for days or weeks. While rare, a basic cancer workup is warranted to rule out a paraneoplastic cause. Dr. Miller reports he is on the speakers bureau for Abbvie and Allergan. The fingers can go through different color changes, says Stojan. Symptoms tend to start about four to 14 days after exposure to the fungus that causes the infection. It's most common in men and adolescent boys. Rarely, patients experience a chronic course lasting longer than six weeks or progress to anaphylaxis.21 In acute cases, a trigger such as infection or allergic reaction may be identified. Calluses, common warts, and other benign conditions can all cause hard. Some people with lupus have another problem with their blood. Leukemia rash may look like tiny red spots, bruising, and petechiae. Researchers are still learning why, but treatments are similar across. Lupus can also lead to pulmonary hypertension, a form of high blood pressure in which the blood vessel connecting the heart to the lungs thickens. Some people develop a nail infection, which can cause splitting or crumbling nails and discoloration (A), or swollen skin and discoloration around the nails (B). ( 8) Other. They feel extremely tired. Its also called chronic cutaneous lupus. Mario J. Sequeira, MD, FAAD, Dermatologists team up to improve patient care, JAK inhibitors: A newer type of medication, Free materials to help raise skin cancer awareness, Dermatologist-approved lesson plans, activities you can use. If you have ringworm, common symptoms include: A circular or ring-like rash that may be raised along the edges A rash that may be scaly, itchy, red, or burning Hair loss in the area where the rash has appeared The rash may develop several red, raised rings at once, some of which may overlap. EM often is confused with large urticarial lesions. Chronic discoid lupus rashes or sores may put you at risk for skin cancer. Non-infectious Granulomas. (Be sure to follow your state laws). Tracts migrate up to several centimeters a day and may disappear then reappear throughout their course.27 Systemic manifestations are not seen, as larvae are unable to invade deeper tissues.27. Appear on your lip or inside of your mouth. Joint pain is a common symptom of lupus. Discoid sores on your lips or inside of your mouth may develop a type of skin cancer called squamous cell carcinoma. Pathogenesis and clinical features of psoriasis. Suh KS, Park JB, Yang MH, et al. The UV radiation damages the cells in the skin, and that exposes antigens that the immune system recognizes, and that leads to an immune response in the skin, says Dr. Stojan. How to tell if i have ringworm or lupus rash? Lupus can cause problems with the kidneys, nervous system, blood vessels, and skin. Prompt treatment of discoid lupus on the scalp can prevent scarring. In: Bolognia JL, Schaffer JV, Cerroni L. James WD, Berger TG, Elston DM. ACLE causes the facial butterfly rash (malar rash). Oral corticosteroids for systemic disease. Therefore, referral to a dermatologist is appropriate. Has circular, coin- or disk-shaped red patches that are thick and scaly. Family history may be helpful in revealing relatives with the disease. The minor variant is not associated with systemic symptoms, but EM major is accompanied by symptoms such as fevers and arthralgias.14, EM minor is characterized by distinctive target-shaped or iris-shaped lesions.14 Lesions evolve over several days, beginning as round, sharply demarcated erythematous macules that progress to raised, edematous papules.4 Mature lesions have three distinct zones a dull red center, a pale outlining ring, and an encircling macular erythema.14 (See Figure 11.) It's not contagious and usually not painful, but it can make you feel self-conscious. Its thought that the rashes occur because of exposure to sunlight, says George Stojan, MD,an assistant professor of medicine in the division of rheumatology at the Johns Hopkins University Medical School and the codirector of the Hopkins Lupus Center in Baltimore. all my blood work is neg (lupus panel) wouldn't it show in blood test? The eruption presents with the same target-shaped lesions seen in EM minor but is accompanied by systemic symptoms and mucosal involvement.14 Erosions and even ulcerations may involve the oral, genital, and ocular mucosa.14,43. Dermatology. The advancing border is raised and may contain vesicles, pustules, or papules.4 Typically, infection begins unilaterally and extends to the medial thighs, perineum, and anus, sparing the scrotum.5 Tinea cruris commonly is found in conjunction with tinea pedis and/or tinea unguium, as the fungus is spread from the infected foot to the groin when clothing is pulled to the waist.2, For localized tinea corporis or cruris, pedis, and faciei, topical antifungals, such as imidazoles (clotrimazole, miconazole, ketoconazole, econazole, oxiconazole, sulconazole) or allylamines (naftifine, terbinafine), should be used once to twice daily for two to six weeks, including two weeks following clearance.2,6 Nystatin, commonly used to treat Candida infections, should not be used to treat tinea.3, Granuloma annulare (GA) is a relatively common, self-limiting disorder of the dermis that affects women twice as often as men.7 The eruption has a predilection for young adults and children, with most cases presenting before the third decade of life.1,7 Although the etiology remains unknown, GA is controversially associated with diabetes mellitus and hyperlipidemia.8 Several clinical variants of GA exist; however, localized disease primarily affects the dorsal surfaces of the fingers, hands, elbows, feet, and ankles.1,7 Lesions are characterized by asymptomatic, erythematous to violaceus colored papules or plaques with a thin, smooth border.9 Lesions develop slowly, spread peripherally, and involute centrally, conferring an annular appearance.9 An isolated (< 5 cm) lesion on the hand or arm represents most cases.7, Granuloma annulare can be diagnosed clinically by its unique distribution and morphology. An estimated 2 out of 3 people with lupus develop a skin disease called cutaneous lupus erythematosus (CLE). Elsevier, China, 2018: 662-80. Lupus rash and skin changes often accompany other symptoms of lupus, which can include fatigue, pain and swelling in the joints, and swollen glands. Discoid lupus causes raised, scaly patches. Skin rashes are a common sign of lupus, an autoimmune disease. does it cause. Often people feel pain and stiffness in their joints, which is called lupus arthritis. Some people have CLE alone, while others have CLE along with a different type of lupus. In: James WD, Berger TG, Elston DM. In: James WD, Berger TG, Elston DM. Avoiding UV light exposure can lessen your chances of developing a lupus skin rash. Discoid lupus, a type of cutaneous lupus, causes circular red rashes on your body. Since skin symptoms of. They appear most often on the neck, chest, upper back, shoulders and arms. 2013 Jun;27(3):391-404. Treatment consists of imidazoles, mainly ketoconazole, as a shampoo when present on the scalp or cream when present on the face and body.36 Topical steroids work quickly and are effective but should be limited because of the risk of steroid rosacea.32 Once cleared, daily maintenance therapy is important to prevent relapse. Among the many organs that lupus attacks are the kidneys, which normally filter blood and remove waste from the body. I trust it will do the same for you. Psoriasis is suggested when lesions occur on the extensor surfaces of the limbs, umbilical region, and sacrum. Itchiness. It is not difficult to tell the difference. How do the rashes associated with annular lichen planus and subacute cutaneous lupus differ in appearance? When available, the diagnosis can be confirmed by observing branching hyphae under the microscope using a potassium hydroxide (KOH) preparation. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Free to everyone, these materials teach young people about common skin conditions, which can prevent misunderstanding and bullying. The key is reapply frequently and avoid sun expos in sle, this is not required for diagnosis. Effective sun-protection helps to prevent this rash, which usually develops on the upper back, upper chest, or arms. In contrast, the term nummular, derived from the Latin word nummulus, meaning coin shaped, is used to describe sharply marginated, round to disc-shaped lesions without central clearing. Bravo FG. Therefore, eruptions occur in regions in which sebaceous glands are most active, such as the scalp, face, eyebrows, ears, and presternal area (see Figure 10), as well as large body folds such as the axillae and groin.36 Lesions are more common in men and are characterized by gradual onset of sharply demarcated patches or thin plaques that vary in color from red to orange to yellow. Patients often are Caucasian women aged 15 to 40 years.42, Because of the transient nature of the eruption, treatment is centered around sun protection.42 If medical therapy is preferred, topical corticosteroids or antimalarial agents, such as hydroxychloroquine, can be used.41, Sarcoidosis is an idiopathic systemic disease characterized by non-caseating granulomas in multiple organ systems mainly the lungs, but also the skin, lymph nodes, eyes, and salivary glands.7,9 The disease is more common in women and typically begins between the ages of 20 and 40 years.9 Interestingly, in the United States, there is marked racial variation, with sarcoidosis affecting African Americans more often than Caucasians.9, Skin involvement is seen in up to one-third of those affected and may be the first and/or only clinical sign of disease.7,9 Lesion morphology varies, presenting as multiple round papules, patches, or plaques that favor the face, neck, and areas of prior injury such as tattoos and scars.7 Color ranges from red to purple to brown.7 Annular configurations may be present when multiple papules coalesce or when plaques clear centrally.7 Applying pressure to the firm lesions causes blanching, sometimes revealing a yellow-brown (apple-jelly) color.7 Lesions are almost always asymptomatic, although rarely may itch.9, Diagnosis may be straightforward in a patient with a known history of sarcoidosis; however, with no prior history, a biopsy of the lesion will reveal non- Jock itch: Tinea cruris, or jock itch, causes a red, itchy rash in your groin, upper thighs or rectum. Difficulty arises when patients present asymptomatically after an eruption, limiting the exam. Hsu S, Le EH, Khoshevis MR. One of the first symptoms of lupus nephritis is edema, or swelling due to fluid buildup in the legs, ankles, and feet. A detailed travel history, recent bites, or outdoor exposures should raise clinical suspicion. Damage, such as scarring, hair loss, and lighter and darker skin, could be permanent in cases of discoid lupus. Lupus vs ringworm Cause: The exact cause behind lupus is not clear, Genetics, environmental factors and the immune system may play a role in it. The eruption can be differentiated from tinea by its lack of scale and distinctive migrating course. Silverberg NB. The chronic nature of the disease often leads to complex treatment regimens requiring combination therapy to achieve control. This autoimmune disease may impact your skin, nails, and hair. Localized granuloma annulare produces annular lesions with smooth, non-scaly contours. Wont scar but might lighten or darken your skin. When systemic lupus flares up, you may notice a sunburn-like rash on your face. Hands (tinea manuum): Signs of ringworm on your hands . People with CLE develop skin rashes or sores, typically on sun-exposed parts of their body. He named the disease lupus, which means wolf in Latin. It can also prevent the flare-up of other lupus symptoms like fatigue and joint pain. Red blood cells transport oxygen-rich blood from the heart and lungs to the rest of the body. lupus? Seborrheic dermatitis is a form of eczema that often affects the scalp. When lupus affects the nails, it can cause: If you have discoid lupus and a darker skin tone, you may develop dark, blue-black nails. We look forward to having you as a long-term member of the Relias In this variant, lesions are characterized by well-demarcated, erythematous plaques with an active border composed of pustules. Last medically reviewed on January 22, 2019, Lupus is an autoimmune disease that can affect almost any part of the body, especially the skin, blood, joints, kidneys, heart, lungs, and brain, Hard skin on your finger can be frustrating, but its usually nothing serious. Erythematous annular or polycyclic plaques with a trailing scale inside an erythematous border. A small percentage of people will develop both this ring-like rash and the one that looks like eczema or psoriasis. The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. This rash usually appears on parts of the body that are exposed to sun, such as the arms, shoulders, neck, chest, and trunk. Cutaneous lupus erythematosus (CLE) affects the skin. In lupus, thrombosis may occur, causing clots to form where theyre not needed. However, treatment generally is not required, as the eruption spontaneously remits in three to eight weeks.12 If patients experience intense pruritus, second-generation antihistamines, topical corticosteroids, a short course of systemic corticosteroids, or narrowband ultraviolet B (UVB) phototherapy can provide symptomatic relief.10. You can learn more about how we ensure our content is accurate and current by reading our. We can sometimes distinguish between different autoimmune diseases based on how those capillaries look under a microscope.. Having SCLE can make you more sensitive to the sun, so you need to be careful when going outside or sitting under fluorescent lights. Healthline Media does not provide medical advice, diagnosis, or treatment. These sores can feel uncomfortable. RELATED: Diagnosing Lupus: Tests and Screenings, Early Diagnosis, and Your Doctors. How can ringworm, shingles, and other rashes appear on darker skin? Doctors typically provide answers within 24 hours. Papulosquamous lesions appear as red scaly areas and can be on the shoulders, back, and chest, whereas annular lesions can appear in circular, ring-type patterns and can look like a fungal infection, says Stojan. Typical and atypical clinical appearance of atopic dermatitis. Ivermectin (adults)/albendazole (children). Advertising on our site helps support our mission. But while a rosacea rash may look like lupus, the difference is that a lupus rash doesn't have red bumps that are typical of rosacea, although the rash can be raised. There are different rashes associated with lupus and many don't itch, but some do. These are most common in people who have systemic lupus erythematosus (SLE). Hair loss, thinning hair, and nail changes are common in people who have different types of lupus. It can be an indication of systemic lupus, but it can also happen on its own, according to NYU Langone Health. Instead of developing a rash that looks like eczema or psoriasis, some people with this type of cutaneous lupus get a ring-like rash from the sun. do you start itching first? Interested in Group Sales? This patient developed a lupus rash after spending time under fluorescent lighting. Light-sensitive skin Lupus can make your skin extremely sensitive to sunlight and other types of light. Nummular eczema is common during the winter months, with crusting, hyperpigmented, coin-shaped plaques on the lower legs, dorsal hands, and extensor surface of the arms. Ring-shaped rash In people with subacute cutaneous lupus (SCLE), the rash looks like scaly red patches or ring shapes. Do you know which one? This can signal subacute cutaneous lupus. This rash reaches across your nose, from cheek to cheek, in a shape that resembles a butterfly. Lab findings may include an elevated erythrocyte sedimentation rate, elevated liver function tests, and mild anemia.18 Serologic evidence of infection is most sensitive between weeks three and six and commonly involves detection of anti-Borrelia antibodies using enzyme-linked immunosorbent assay (ELISA), followed by a Western blot for confirmation.17, Adults should be treated with a 21-day course of doxycycline.18 Amoxicillin, cefuroxime, and penicillin can be used in pregnant women and children younger than 8 years of age.18 If significant rheumatologic, neurologic, or cardiac complications are present, more aggressive regimens consisting of intravenous antibiotics should be used.18, Often referred to as hives, urticaria is an extremely common skin eruption that occurs in up to 20% of the population.20 Most cases are benign and resolve spontaneously. Well-circumscribed, erythematous dry plaques with silvery scale. Normally, the immune system protects the body against foreign invaders like viruses and bacteria. You have reached your article limit for the month. Can begin with a herald patch, followed by a diffuse eruption involving the trunk and proximal extremities. Tinea corporis produces well-demarcated, erythematous, dry, and scaly lesions with raised red borders and central clearing. Damage, such as scarring, hair loss, and lighter and darker skin, could be permanent in . Treating a scaly patch of discoid lupus on the scalp before it scars (A) can prevent permanent hair loss (B). When you have subacute cutaneous lupus, red borders develop around the edges of these lesions. Lupus occurs when cells in your immune system that typically fight off infections turn against your body and attack healthy cells. Mycobacterial Infections. If the rash is on the scalp, hair loss may occur. When scars develop on the scalp, hair cannot grow where there are scars. The Best and Worst Diets for Heart Health, Type 2 Diabetes Drug Mounjaro Leads to 16 Percent Weight Loss in New Trial for Treatment of Overweight or Obesity. One way to make that diagnosis is through a biopsy, in which a doctor takes a tissue sample and examines it under a microscope. We use cookies to create a better experience. Lupus erythematosus. In: Bolognia JL, et al. In: Bolognia JL, Schaffer JV, Cerroni L. Piette EW, Rosenbach M. Granuloma annulare: Pathogenesis, disease associations and triggers, and therapeutic options. It has a red, ring like pattern,sometimes with a little scaling in sun exposed areas, and may be confused withpsoriasis or ringworm. If the fungal test is negative . In lupus, the immune system can damage healthy red blood cells. In: Bolognia JL, Schaffer JV, Cerroni L. Barrett M, Luu M. Differential diagnosis of atopic dermatitis. James WD, Berger TG, Elston DM. It appears by the malar area of the cheeks around your cheekbones "and it has the shape of a butterfly as it goes across the bridge of the nose, says Dr. Werth. It causes rough, scaly skin to develop on the face and scalp. First they turn white, then blue, and then when the blood supply returns, they turn red, but you dont need all three stages to have Raynauds, he says. This damage can lead to a range of symptoms, including: When lupus attacks nerves to the hands and feet, it can cause Raynauds phenomenon, which causes the tips of the fingers or toes to turn red, white, or blue. Learn which joints it usually affects and what you can do to manage the pain. Hotzenecker W, Prins C, French LE. Primary lesions can reach 15 cm in diameter and commonly are found on the trunk, axilla, groin, and popliteal fossa.17,18 Days to weeks following the primary eruption, a subset of patients will develop secondary lesions that are smaller and less pronounced than the primary lesion. It includes over 1,000 articles published annually, She says learning to cope with the emotional toll of the chronic condition has been the hardest A chronic condition like lupus introduces a lot of stressors to ones everyday routines. 2010;62(4):667-71. Not All Round Rashes Are Ringworm: A Differential Diagnosis of Annular and Nummular Lesions. (https://jamanetwork.com/journals/jamadermatology/fullarticle/1818978). Lesions may be dry, scaly, and hairless, but most importantly, anesthetic.44,45 The superficial nerves supplying the area may be enlarged, tender, and palpable.1,45, The lepromatous form represents a poor cell-mediated immune response.45 Patients present with generalized disease, consisting of numerous, symmetrically distributed lesions characterized by small, poorly defined hypopigmented macules without associated anesthesia.45 Eventually, nodules and raised plaques of the face (leonine facies), ears, elbows, hands, and knees may appear.45 Nerve involvement can occur, but will present as a symmetric stocking-glove pattern neuropathy.45, Diagnosis of Hansens disease is made by identifying the infectious acid-fast bacilli in skin or nerve lesions with biopsy.45 In the United States, tuberculoid leprosy is treated with a combination of dapsone and rifampin for 12 months.45 Lepromatous leprosy is treated with a combination of dapsone, rifampin, and clofazimine for two years.45.
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