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Variations in clinical and histopathological classification of leprosy--a report and a plausible explanation.

Biopsies of macular hypopigmented lesions, in twenty one untreated cases, representing the whole spectrum of leprosy, revealed a high incidence of disagreement between clinical and histopathological classification. It was not observed in macular tuberculoid and indeterminate cases but was seen in borderline and lepromatous leprosy, with highest incidence in borderline leprosy. This has been explained on the basis of complex nervous system with a mosaic of anatomical and physiological subunits, modulating different types of responses including inflammation, through release of peptides and/or enzymes at the nerve endings in the peripheral tissues including skin.