03406nas a2200229   4500000000100000008004100001260001200042653002000054653001900074653001400093653001500107653001200122100001300134700001600147700001300163700001700176245010300193856012500296300001400421490000700435520273400442       2026                            d  c05/202610aPigment Network10aHistopathology10aGranuloma10aDermoscopy10aLeprosy1 aN Gupta 1 aA Mahendra 1 aS Gupta 1 aVS Nijhawan 00aDermoscopic Insights in Leprosy: A Cross-sectional Observational Study from a Tertiary Care Centre  uhttps://www.ijl.org.in/published-articles/30092026095145/3_Original_Article_Gupta_et_al_July_Sept_2026_print_version.pdf  a233 - 2550 v983 a<p>Leprosy is a chronic granulomatous disease with diverse clinical manifestations, often complicating diagnosis. Dermoscopy, a non-invasive diagnostic tool, facilitates real-time, magnified visualisation of cutaneous morphological features imperceptible to the naked eye. This study has been carried out to assess dermoscopic features across the leprosy spectrum and correlate them with histopathological findings. This cross-sectional observational study was conducted at the Dermatology Outpatient Department of Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana. Thirty-six newly diagnosed, untreated patients with clinically suspected leprosy were enrolled. All patients underwent detailed clinical evaluation followed by dermoscopic examination of the most representative lesion using a handheld dermoscope. Slit-skin smear (SSS) examination was performed in all cases and stained using Ziehl–Neelsen technique, and graded according to the bacillary index (BI). Skin biopsy was performed in each patient for histopathological confirmation, and acid-fast bacilli (AFB) were also assessed. Dermoscopic findings were studied across different spectrum of leprosy and correlated with histopathological features. Among the 36 patients (male-to-female ratio: 1.77:1), borderline tuberculoid (BT) and borderline lepromatous (BL) were the most prevalent clinical types (27.8% each). Slit-skin smear examination demonstrated acid-fast bacilli (AFB) positivity in 83.3% of patients, with the majority showing low to moderate bacillary load; BI 1+ was the most frequent grade. Histopathologically, AFB were absent in 50% of cases, while positive biopsies exhibited bacillary indices ranging from 1+ to 6+. Dermoscopic evaluation revealed characteristic findings, including localised white structureless areas (61.1%), reduced white pinpoint dots (69.4%), decreased appendages (63.9%), diffuse erythema (69.4%), outof-focus vessels (61.1%), and peripilar scaling (72.2%). A broken pigment network was the most consistent dermoscopic feature (88.9%). Clinical and histopathological diagnoses were concordant in 72.2% of patients. It is concluded that dermoscopy enhances the clinical evaluation of leprosy by revealing subtle morphological changes that correlate well with histopathological findings. The reduction in eccrine gland openings and hair follicle density represents a key diagnostic feature of paucibacillary leprosy and helps distinguish it from other infectious and non-infectious granulomatous dermatoses. Simple, rapid, and non-invasive, dermoscopy serves as a practical adjunct that improves diagnostic confidence and supports early, accurate classification in routine clinical practice.</p>