The first sign of leprosy is often the development of a pale or pink-colored patch on the skin. The patch may be insensitive to temperature or pain.
Skin patch, which is considered one of the symptoms of leprosy, differs in color from the rest of your skin. In African Americans, these skin patches are lighter. In Caucasian people, the patches are reddish.
Leprosy does not cause the skin and hair to turn white (like in vitiligo).
What is leprosy?
Leprosy or Hansen’s disease, which is very contagious, is caused by the bacteria called Mycobacterium leprae. This chronic disease can be passed on from one person to another through prolonged contact or exposure to the nasal and oral secretions of the infected person.
The infection can be contracted at any age and affects not only the skin but also the peripheral nerves, mucosa of the upper respiratory tract and the eyes. If left untreated, leprosy can lead to muscle weakness, significant disability, disfigurement, permanent nerve damage in the arms and legs and even loss of sensation in the body.
The symptoms of Hansen’s disease may be very different depending on the type of the disease and the affected part of the body, and may include:
- Loss of feeling in the hands and feet
- Muscle weakness, nodules on the body and a blocked or stuffy nose
- Paralysis, blindness and chronic ulcers, if left untreated
The largest risk factor for leprosy is contact with another person who is infected with Mycobacterium leprae.
Even malnutrition plays a part in developing leprosy. Individuals who live with poor conditions, such as inadequate bedding and contaminated water, are also at a higher risk of the disease.
The six types of leprosy are:
- Intermediate leprosy: In this form, only some lesions appear that may heal on their own or turn into a more severe form.
- Tuberculoid leprosy: Symptoms may include skin sores or lesions, which may be big. The skin area could be numb due to nerve damage. This form of leprosy may heal by itself, continue or increase to a greater degree of severity.
- Borderline tuberculoid leprosy: In this form, wounds are like tuberculoid though smaller in size and more in number with less nerve involvement. This form may continue, change to tuberculoid or progress to other forms of the disease.
- Mid-borderline leprosy: Symptoms of this form are swollen lymph glands, rosy lesions with some numbness, which may reduce, continue or advance to severe forms.
- Borderline lepromatous leprosy: Numerous lesions, some of which are flat, raised wounds, plaques and lumps with numbness around the area. The symptoms may continue, retrogress or progress.
- Lepromatous leprosy: In this form, numerous lesions develop with the presence of bacteria. The patient has hair loss, nerve impairment, limb numbness and disabilities. The symptoms do not retreat.
How is leprosy treated?
Management of leprosy aims to treat the infection and minimize potential physical deformities.
The choice of antibiotics depends on the type of leprosy being treated, and may include:
- The forms of leprosy with fewer bacilli (paucibacillary leprosy) often respond well to rifampicin and dapsone. These are used for six months.
- The more severe lepromatous form of leprosy (multibacillary leprosy) requires the addition of clofazimine. The treatment lasts for 12 months or longer.
- If a certain drug cannot be given due to allergy or other side effects, ofloxacin or clarithromycin are considered substitutes.
Leprosy is not usually treated with a single drug because of the risk of the development of drug resistance.
- Oral steroids and thalidomide help prevent nerve damage.
- Surgery may be necessary to reconstruct a collapsed nose, decompress a nerve abscess or manage limb deformities.
- Physical, social and psychological rehabilitation is necessary for untreated leprosy.
Reactions to leprosy treatment
Reactions to leprosy treatment are called lepra reactions and may occur due to changes in the immune system.
There are two types of lepra reactions:
- Lepra type I reaction causes inflammation of pre-existing lesions and tender enlarged peripheral nerves. This is treated with oral corticosteroids and anti-inflammatories.
- Lepra type II reaction, also called erythema nodosum leprosum, is an immune complex reaction. The red nodules can blister or ulcerate. It can be accompanied by fever, joint pains, nerve pains, eye disease and possible involvement of other organs. Medications for treatment may include clofazimine, thalidomide, corticosteroids and colchicine.
While antibiotics can kill bacteria, they cannot reverse the damage done. If you already have a permanent disability, such as loss of feeling or blindness, antibiotics cannot return those feelings. However, with appropriate treatment, leprosy is eminently curable.
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American Academy of Family Physicians. Leprosy. https://familydoctor.org/condition/leprosy/
Riley G. Medical History: Leprosy Is a Terror of the Past. Right? RACGP. https://www1.racgp.org.au/newsgp/clinical/medical-history-leprosy-is-a-terror-of-the-past-ri
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