What skin changes occur in tuberculoid leprosy?

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Sign reading Gandhiji Prem Nivas Leprosy Centre Titagarh conducted by Missionaries of Charity, with a crucifix above the sign on a decorated building facade. — leprosy The Gandhiji Prem Nivas is a center for people with leprosy that was established by Mother Teresa in 1958 and is run by the Missionaries of Charity in Titagarh, India.

In tuberculoid leprosy, the body’s immune response involves the formation of hard nodules, or tubercles, within the deep layers of the skin. This intense cellular reaction affects the entire thickness of the skin, including the sweat glands and hair follicles.1

Clinically, this manifests as a firm, dry patch on the skin. A defining characteristic of these patches is the loss of sensation, specifically the inability to perceive heat, cold, or touch. Because the cellular reaction also impacts the nerve fibers ending in the skin, patients lose the ability to feel pain in the affected areas, which can lead to unnoticed injuries and the development of large, eroding ulcers.1