01921nas a2200193 4500000000100000008004100001260003400042653001300076653002300089100001500112700002000127700000900147700001400156700001600170245010500186856026000291520116200551022001401713 2020 d bOxford University Press (OUP) 10 aOncology 10 aClinical Neurology 1 aGranger DL 1 aRosado-Santos H 1 aLo T 1 aFlorell S 1 aShimwella R 00 aFunctional impairment of skin appendages due to peripheral nerve involvement by Mycobacterium leprae uhttps://watermark.silverchair.com/ofaa419.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArgwggK0BgkqhkiG9w0BBwagggKlMIICoQIBADCCApoGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMDHiHKMgTPUOYmHs_AgEQgIICa2XnEHcPZjJ3ZXqoAnlePofIcr83QAQ17iGDYjD3_I8k-mU 3 aAbstract
In the earliest stage of Mycobacterium leprae infection bacteria parasitize fine fiber twigs of autonomic peripheral nerves supplying efferent impulses to appendages of the skin. This obligate intracellular pathogen invades Schwann cells, the glial cells of peripheral nerves. Intracellular events inhibit Schwann cell physiology in complex ways which include demyelination and dedifferentiation. Ultimately axons embraced by their surrounding dysfunctional glia are damaged by poorly understood mechanisms. Loss of nerve conduction impairs the functions of skin appendages including hair growth, sebaceous gland secretion, sweating, and skin pigmentation. At the clinical level these changes may be subtle and may precede the more obvious anesthetic skin lesions associated with Hansen’s disease. Recognizing the early signs of skin appendage malfunction may aid in diagnosis leading to initiation of antimycobacterial treatment. Effective therapy administered early during infection may prevent irreversible peripheral nerve destruction, the presage for morbid complications of leprosy. a2328-8957