Inflamed skin lesions along the course of a nerve as patient self-help proxy indicator of nerve abnormalities in leprosy

Abstract

Objectives This study sought to determine the acceptability and utility of a selfassessment tool using inflamed skin lesions as proxy indicator of nerve abnormalities; and if nerve proximity to these skin lesions increases the risk of nerve abnormality and deformity in leprosy. Methods A cohort of 200 Filipino patients were monitored before and during reaction. Using a self-assessment tool, skin lesions were independently scored by the patient and a clinician, while the nerves were assessed by a clinical staff. Skin lesions and nerves were scored on a 0-15 severity scale; and nerves were noted as near or distant from the skin lesion. Skin lesions with type-1 or type-2 reactions were included. Results A total of 314 inflamed skin lesions matched with the same number of nerves near and distant from skin lesions were studied. There was no significant difference (P = 0.1771) in skin lesion scores independently determined by the patient and the clinician. Mean skin lesion score was 2 in the absence of a reaction; and 5 at the peak of a reaction. Nerve scores remained low in the absence of a reaction, and when a reaction occurred in the skin lesion distant from the nerve. However, nerve scores were significantly higher when a skin lesion near the nerve became inflamed (0.24 vs 1.03; P < 0.0001). Among these skin lesions, 15% had nerve findings before the skin reaction; 32% had both nerve and skin findings, while 53% had skin reaction without nerve findings. At the peak of a reaction, seven new episodes of visible disability were recorded with skin lesion and nerve scores >= 3; and all nerves involved were located near inflamed skin lesions. No deformity was associated with nerves distant from inflamed skin lesions. Ninety-five percent (95%) of patients considered the tool highly acceptable, important and beneficial. utility of a self-assessment tool using inflamed skin lesions as proxy indicator of nerve abnormality; and that with adequate training,patients can reliably be delegated to monitor their own skin lesions. This study also demonstrates the higher risk of deformity and abnormality among nerves near inflamed skin lesions.