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==leprosy==
*manifests in skin and peripheral nerves
*papule, macule, plaque, hypopigmentation, nodule
*loss of sensation, paralysis, amyotrophy
*incubation months to >30 years
===Ridley-Jopling classification===
*TT - tuberculoid
*BT - borderline tuberculoid
*BB - borderline borderline
*BL - borderline lepromatous
*LL - lepromatous
*TT direction - abnormal or significant immune response (granulomatous) against few ''M. leprae'' bacilli
**PB in WHO classification
**infiltrated plaque
**well-defined, sharp border
**single skin lesion
**localized, asymmetrical
**loss of sensation at skin lesion
***in histopathology nerves are surrounded by granuloma
*LL direction - least cellular immunity or allergic reaction against much amount of ''M. leprae'' bacilli
**MB in WHO classification
**macule, papule, nodule
**multiple skin lesion
**widespread, symmetrical
**loss of sensation at ...
***in histopathology diffuse infiltrate of foamy histiocytes (macrophages) in dermis
***Leonine facies: madarosis, saddle nose
===diagnosis===
*WHO criteria: one or more cardinal signs
#skin lesion consistent with leprosy with definite sensory loss
#thickened nerve, peripheral neuropathy
#skin smear...
===treatment===
*MB >5 lesions
**
*PB 1-5 lesions
**
===leprosy reaction===
*can develop at anytime on clinical course
**either before or after commencement of treatment
**even after completion of treatment
*incidence 20-60% in multiple studies
*
*Type 1 reversal reaction
**cell-mediated delayed hypersensitivity
**reddish, swollen, warm, painful, tender
**systemic condition fair
*Type 2 erythema nodosum leprosum (ENL)
**antigen-antibody immune complex reaction
**multiple, distributed bilaterally and symmetrically
**with high grade fever and malaise
====treatment of leprosy reaction====
*antipyretics, NSAIDs
*steroid
*immunosuppressant
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==skin mycobacterial diseases==
*leprosy
==when to suspect==
*skin symptoms without '''WITHOUT''' inflammatory sings (pain, swelling, redness)
*slow progression
*specific patient background
**occupation, living place, triggering event
==cutaneous TB==
*''M. peregrinum''
*''M. massiliense'' (''M. abscessus'' subsp. ''massiliense)
===treatment===
*use more than two antibiotics to prevent from resistance
*clarithromycin, rifampicin, quinolone, minocycline..
*NO standarized regimen nor treatment duration
==Buruli ulcer==
===diagnosis===
*mandatory
**skin manifestation
**histopathology
**PCR
*indigenous Buruli ulcer in Japan
**''M. ulcerans'' subsp. ''shinshuense''
*total 76 cases during 1980-2020
*in all age
*[https://www.niid.go.jp/niid/ja/id/838-disease-based/ha/buruli-ulcer.html 感染研：ブルーリ潰瘍]
