In lepromatous leprosy the changes in the skin are the earliest manifestation of the disease.
Commonest sites for the skin lesions are the face, gluteal region and the upper and lower limbs. Different skin lesions that may occur include macules, papules and nodules; they are not, unlike those seen in tuberculoid leprosy, anaesthetic. There may be characteristic thinning of the lateral margins of the eyebrows. Skin ulceration associated with lepromatous leprosy - Lucio's phenomenon - is seen in cases of leprosy in Mexico and Central America. Nasal involvement commonly occurs and causes stiffness and epistaxis.
In lepromatous leprosy there may be the development of nerve palsies - facial, ulnar, median, radial. A glove and stocking sensory neuropathy is associated with lepromatous leprosy. There may be gradual disappearance of the fingers due to neurotrophic atrophy affecting the phalanges.
The lepromin test is negative.
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