Tuberculoid: The CMI restricts the diseases to the skin and the nerves number of lesions are to less than three lesions. In the skin it may manifest as macules or plaques. Macules are well defined hypopigmented macules of an insidious onset and slow evolution. There may be impairment or complete loss of sensation. It may also exhibit loss of nevi and loss of sweating with dryness. A thickened cutaneous nerve may course over the lesion.
If it is a plaque in addition to the earlier features the lesion is raised as a whole or only at the borders with central clearing. The lesion may be studded with a pebbly surface.
If a nerve trunk is involved it is solitary and there may be nodular irregular thickening with corresponding sensory and motor sequelae of a single nerve trunk involvement
Borderline: Borderline can present with multiple lesions like Tuberculoid. Satellite lesions, large bizarre lesions, annular erythematous lesions
Early and greater involvement of the nerve trunks may be present. More than one nerve trunk may be involved with sudden onset of nerve abscesses with their motor and sensory sequelae may occur especially in BT and BB.
Lepromatous: manifests with macules, plaques, nodules and diffuse infiltration of the skin.
Macules are numerous, bilateral and symmetrical with vague and ill defined borders. Trophic changes over the lesions are minimal. There is diffuse infiltration of the skin with shiny succulent appearance. Edematous, shiny succulent nodules may be present mainly over face, especially over the ear. Diffuse thickening of the face, thickening of the ear, depression of the bridge of the nose and loss of eyebrows will constitute the leonine facies. Ciliary madarosis can occur with superciliary madarosis. Destruction of nasal cartilages can occur along with loss of alveolar processes resulting in "Facies leprosa".
Bilateral and symmetrical involvement of superficial palpable peripheral nerve trunks with smooth regular thickening results in "glove and stocking type of anesthesia" and multiple symmetrical motor deficits and deformities.
Nasal stuffiness and epistaxis can occur. Ulceration of pharynx and larynx may lead to hoarseness of the voice. All structures of the eye can be involved resulting in partial or complete blindness.
Involvement of testis results in impotence, sterility and gynecomastia. In the late stages glomerulonephritis, nephrotic syndrome renal amyloidosis with renal failure occurs.
