Identical twins with borderline lepromatous leprosy mimicking extensive alopecia areata: A rare presentation

Nineteen-year old identical female twins presented with complaints of progressive hair loss all over the body, sparing the scalp, axillae and pubic region along with a few atrophic scars on the knees, thighs and elbows. A possible diagnosis of atypical presentation of alopecia areata was made. However, in view of history of borderline tuberculoid leprosy in their younger sibling, a complete examination for leprosy was done. There was asymmetrical enlargement of multiple peripheral nerves without any sensory or motor loss. Histopathology confirms the diagnosis of BL Hansens. Such a presentation of leprosy in identical twins is not reported in literature.