HISTOPATHOLOGICAL STUDIES ON LEPROTIC MAL PERFORANS PEDIS

Abstract

The histopathological picture and mechanism of leprotic mal perforans pedis was studied and the following observed.
(1) Leprotic mal perforans pedis occurs in the presence of anaesthesia (atrophy of the skin and intracorial arterial hypertrophy) and stimulation by an outside factor as a wound or burn. The added stimulation of the mechanical pressure of walking on the affected part is also required.
(2) The typical histopathological picture in this condition consists of hyperkeratosis, acanthosis, papillomatosis, parakeratosis, proliferation of connective tissue cells in the corium, slight lymphocytic infiltration, collagenous and elastic fiber degeneration and arteritis obliterans besides a characteristic granular tissue. This granular tissue is made up of 3 layers, necrotic layer (due to deposition of fibrinoid masses), necrobiotic layer and reaction layer. It is similar to ulcerative granulation and there is marked proliferation of connective tissue cells, a high degree of degeneration of vessels and edema with little infiltration of vascular cells.
(3) It is suggested that this characteristic granular inflammation is due to a disturbance in the communication of sensations to the central nervous system resulting from the anaesthesia and the occurrence of a disturbance in the anti-inflammatory nervous regulation.
(4) Leprosy bacilli cannot be isolated from the site of perforation and the arteritis obliterans is a secondary change arising from the inflammatory stimulation, so it can be said that neither are essential causes of leprotic mal perforans pedis.