GD07 Clinicodermoscopic and histopathological correlation in Hansen disease: a cross-sectional observational study from a South-East Asian tertiary care centre

Abstract

Hansen disease remains a significant public health concern in endemic regions, with heterogeneous clinical and morphological presentations often resulting in delayed diagnosis and ongoing transmission. While clinical examination and histopathology remain the diagnostic gold standards, dermoscopy has emerged as a noninvasive adjunct in granulomatous dermatoses. However, its diagnostic relevance in Hansen disease remains incompletely characterized. Our aim was to evaluate the clinical, dermoscopic and histopathological spectrum of Hansen disease and to assess the concordance between these diagnostic modalities. A cross-sectional observational study was conducted at a tertiary care dermatology centre involving 53 patients diagnosed with Hansen disease. All patients underwent detailed clinical examination, slit-skin smear analysis, dermoscopic evaluation using a handheld dermatoscope, and histopathological assessment. Cases were classified across the immunological spectrum. Agreement between clinical, dermoscopic and histopathological diagnoses was analysed using χ2-testing and Spearman correlation. Dermoscopic examination revealed recurring but non­specific features across the disease spectrum, including yellowish-orange structureless areas, patchy hypopigmentation, reduced hair density, and surface scaling. Certain vascular patterns were more frequently noted in lepromatous forms. However, considerable overlap of dermoscopic findings was observed across immunological subtypes. Histopathological assessment demonstrated characteristic granulomatous patterns corresponding to the tuberculoid and lepromatous poles. Overall concordance between clinical, dermoscopic and histopathological diagnoses was limited and did not reach statistical significance, underscoring the heterogeneity of presentations of Hansen disease. Dermoscopy demonstrates reproducible but nonspecific patterns across the immunological spectrum of Hansen disease. It should be regarded as a complementary diagnostic tool rather than a standalone modality. This study highlights dermoscopy as a practical, noninvasive adjunct that enhances clinicopathological correlation in Hansen disease and may facilitate earlier recognition and improved disease stratification, particularly in resource-constrained settings.