Table 1. Differentiating features between Lucio's phenomenon and type 2 lepra reaction with vasculonecrotic phenomenon
Lucio phenomenon |
Type 2 lepra reaction with vasculonecrotic phenomenon |
Occurs only in the diffuse form of leprosy when no nodules appear erythematous spots appear without localized infiltrations (diffuse leprosy that never presents papules, plaques or lepromas in the course of disease) and evolve into small superficial ulcerations, generally triangular or angular, that heal leaving atrophic and hypochromic scars. |
Occurs in leprosy with plaques and nodules, vasculonecrotic lesions with eschars are formed.
|
Occurs in untreated individuals, a few years after onset of disease and, disappears with treatment being sometimes replaced by erythema nodosum |
More frequent in the first months of treatment |
Reddish 0.5 to 1.0 cm spots that ulcerate |
Extensive and deep necrotic lesions, regular and round or oval ulcerations overlying a nodule. |
Burning sensation |
Ischemic pain |
Usually afebrile, never appear to be acutely ill, except in severe cases of extensive necrosis. |
Presents with fever and constitutional symptoms
|
Does not affect nerves |
It may be accompanied by neuritis |
No general symptoms or visceral damage |
Arthralgia, iridocyclitis, orchitis, lymphadenopathy, nephritis, hepatitis |
Positive Medina test |
Negative Medina test |
Histopathology shows colonization of the endothelial cell by acid fast bacilli, ischemic epidermal necrosis, necrotizing vasculitis of the small vessels of the superficial dermis, endothelial proliferation of the medium-sized vessels of the mid-dermis with passive venous congestion, and neutrophilic infiltration. |
Histopathology shows panvasculitis develops. It starts in the hypodermis, where the affected vessels are of variable caliber, with larger necrosis resulting in fibrotic scars.
|
Does not respond to thalidomide |
Responds to thalidomide |
Resolution in 15 days |
Slow resolution |
Small hypochromic scars with hyperchromic border |
Large deep ulcers result in fibrotic, hypertrophic and radiated scars |