Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2025;15(4):6738 1

Type 2 Lepra Reaction with Borderline  
Lepromatous Leprosy

Qiuping Chen1, Jifeng Liu1

1 Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China

Citation: Chen Q, Liu J. Type 2 Lepra Reaction with Borderline Lepromatous Leprosy. Dermatol Pract Concept. 2025;15(4):6738.  
DOI: https://doi.org/10.5826/dpc.1504a6738

Accepted: September 19, 2025; Published: October 2025

Copyright: ©2025 Chen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication. 

Corresponding Author: Jifeng Liu, ID, Department of Dermatology, Hangzhou Third People’s Hospital. ORCID ID: 0000-0001-6556-2440. 
E-mail: fliu8166@126.com 

Case Presentation

A 37-year-old female was admitted due to recurrent ery-

thema, papules, and nodules over her body for six months 

and intermittent fever for two months. Physical examination 

revealed erythematous papules and plaques on the limbs and 

trunk (Figure 1A) and erythematous nodule on the earlobe 

(Figure 1B). The skin examination showed high-density lep-

rosy bacilli (2+). Histopathological examination of the skin 

tissue showed lymphocyte and histiocyte infiltration around 

the blood vessels (Figure 1C). A diagnosis of type 2 leprosy 

reaction with borderline lepromatous leprosy was made. 

Teaching Point

Type 2 lepra reaction is an acute inflammatory response 

triggered by immune complex deposition during the course 

of leprosy, most commonly occurring in patients with lepro-

matous (LL) or borderline lepromatous (BL) leprosy. Skin 

symptoms are painful red nodules or papules on the limbs or 

trunk, which may ulcerate and suppurate [1]. The first-line 

drugs are thalidomide and prednisone [2], so the patient was 

treated with oral thalidomide and prednisone, along with 

multidrug therapy for leprosy. The erythema nodosum basi-

cally subsided after three months. 



2 Image Letter | Dermatol Pract Concept. 2025;15(4):6738

References

1. Carneiro S, Nakasato FK, Balassiano V, et al. Lepromatous 

Reaction Type II: Clinical and Laboratory Aspects. Skinmed. 

2019;17(4):261-265. Published 2019 Jul 1. PMID: 31627788.

Figure 1. (A) Multiple erythematous papules and plaques on the trunk. (B)  Erythematous 

nodule on the earlobe. (C) Histopathology (H&E, x100): Subcutaneous fat shows 

 vascular embolism with infiltration of tissue cells and lymphocytes.

2. Bhat RM, Vaidya TP. What is New in the Pathogenesis and 

 Management of Erythema Nodosum Leprosum. Indian Der-

matol Online J. 2020;11(4):482-492. Published 2020 Jul 13. 

DOI:10.4103/idoj.IDOJ_561_19. PMID: 32832433.