Evolution of in situ immune responses in clinical subgrounps of erythema nodosum leprosum reactions of leprosy: an Immunoperoixdase study using suction-induced skin blisters.

This work a supported in pan by USAID (Grant No. PDC-5542'G55-5033 Oj and from the UNDP/WorJd Bank/WHO Special Programme for Research and Training in Tropical Diseases. By performing suction induced skin blisters at different periods of time and staining cells with monoclonal antibodies using immunoperoxidase method, the numbers and ratio of T Iympho:yte subsets in the lesions of two clinical subgroups of E L reactional state of leprosy (13 acute ENL and 17 chronic, recurrent ENO were determined and compare with those found in stable, non-reaclional patients (9 borderline lepromatous and 1I lepromatous). In acute and chronic, recurrent E L, the percentages of the helper (inducer) phenotype were significantly higher han those found in non-reactional lepromatous lesions; but only chronic, recurrent ENL showed significantly larger helper/suppressor ratio. The increase in helper activity with or without the reversal of the helper!suppressor ratio in two clinical subgroups of ENL as compared to non-rcactional lepromatous disease suggests some role for cell-mediated immunity 10 the pathogenesis of ENL. The non-invasive blister technique may be used for monitoring immune status and improving treatment, particularly in the chronic, recurrent subgroup of ENL reactions of leprosy.