What is it about?
We present a clinical image of a 56-year-old Italian man who had spent 25 years in Venezuela. He had red skin lesions on his face, chest, arms, feet, knees and scrotum, numbness of his hands and feet, and loss of sensation and sweating in the affected skin. Strikingly, the outer third of both eyebrows was missing - the Hertoghe sign, also called Queen Anne sign. A skin biopsy showed acid-fast bacilli invading the nerves, confirming lepromatous leprosy. He started multidrug therapy and close follow-up to prevent disability. Eyebrow loss occurs in about three quarters of patients with multibacillary leprosy and is caused by infiltration and atrophy of hair follicles.
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Photo by Christopher Campbell on Unsplash
Why is it important?
Leprosy is rare in Europe but still exists, especially among people who lived in endemic countries, and early diagnosis prevents nerve damage and disability. Recognizing simple signs like the Hertoghe sign, together with numb skin lesions, can prompt the right diagnosis. The sign can also appear in hypothyroidism and syphilis, which should be considered in the differential diagnosis.
Perspectives
Leprosy is a disease many European doctors only read about in textbooks. Seeing a textbook sign so clearly in our clinic in Trieste was a reminder that global mobility brings ancient diseases into our daily practice, and that a careful look at the patient face can be diagnostic.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Hertoghe sign: a hallmark of lepromatous leprosy, QJM, March 2016, Oxford University Press (OUP),
DOI: 10.1093/qjmed/hcw046.
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