By A. Colin McDougall, Yo Yuasa

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In this form of (MB) leprosy, the lesions are typically raised and slope down towards the skin level at the edges, like an inverted saucer. This is in contrast to the findings in many of the PB patches shown in Figures 1–13. Multibacillary (MB) leprosy. 31 32 MULTIBACILLARY (MB) LEPROSY 22. The whole of the back and most of the arm surface show symmetrically distributed flat (macular) lesions. Skin smears were strongly positive. It was not possible to demonstrate loss of sensation in these lesions, but the skin smears were strongly positive and three peripheral nerves were enlarged.

The lower picture illustrates a much less common widely distributed form. Papules or nodules appear in a ring-like (annular) pattern. Lesions are symptomless and there are no enlarged peripheral nerves. Sensation and sweating are normal.

MULTIBACILLARY (MB) LEPROSY 23. This boy shows active MB leprosy with patches on the face and neck, and many rounded or oval small lumps (nodules) on the right ear. The other ear was similarly affected. Always examine the ears in this form of leprosy. In some cases they are the main, or even the only, site of swelling and/or nodule formation. Multibacillary (MB) leprosy. 33 34 NEURAL LEPROSY On the left, enlarged nerves are shown in the neck. This is a common finding in clinical leprosy. Visibly enlarged nerves, as shown here, are valuable in making the diagnosis of leprosy, because such enlargement does not occur in other conditions.

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A New Atlas of Leprosy by A. Colin McDougall, Yo Yuasa

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