Pts develop symmetrically distributed skin nodules, raised plaques, and diffuse dermal infiltration that can cause leonine facies, loss of eyebrows and lashes, pendulous earlobes, and dry scaling.
Numerous bacilli are present in skin (up to 109/g), nerves, and all organs except the lungs and CNS.
Nerve enlargement and damage are usually symmetric and are due to bacillary invasion.