I was interested in the distribution of "non-trophic cutaneous ulcers" shown on the knuckles and dorsal foot in the case report of a 44-year-old female with multibacillary Hansen's disease or leprosy.1 The case had glove stocking sensory and motor neuropathy and histopathology characteristics of multibacillary Ridley Jopling borderline lepromatous or lepromatous leprosy. The patient was treated with three effective drugs and reportedly had resolution of her neuritis symptoms and dorsal pressure ulcers of her knuckles and upper feet. Although she may not have had classic neurotrophic plantar ulcers in the soles or weight-bearing surfaces of the foot, her skin ulcers appeared in hyperpigmented areas, where her sandal straps and toe thong might have rubbed the dorsal foot arch and big toe. The dorsal foot ulcers may then have been true neuropathic skin breakdowns from the rubbing of her sandal straps and thong on the hallux of her insensate foot.
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