Leprosy (Hansen's disease) facts

 Leprosy is a slowly developing, progressive disease that damages the skin

and nervous system.
 Leprosy is caused by an infection with Mycobacterium leprae or M.
lepromatosisbacteria.
 Early symptoms begin in cooler areas of the body and include loss of
sensation.
 Signs of leprosy are painless ulcers, skin lesions of hypopigmented
macules (flat, pale areas of skin), and eye damage (dryness, reduced
blinking). Later, large ulcerations, loss of digits, skin nodules, and facial
disfigurement may develop.
 The infection is thought to be spread person to person by nasal secretions
or droplets. Leprosy is rarely transmitted from chimpanzees, mangabey
monkeys, and nine-banded armadillos to humans by droplets or direct
contact.
 Susceptibility to getting leprosy may be due to certain human genes.
 Antibiotics are used in the treatment of leprosy.

What is leprosy?
Leprosy is a disease mainly caused by the bacteria Mycobacterium leprae, which
causes damage to the skin and the peripheral nervous system. The disease
develops slowly (from six months to 40 years) and results in skin lesions and
deformities, most often affecting the cooler places on the body (for example,
eyes, nose, earlobes, hands, feet, and testicles). The skin lesions and
deformities can be very disfiguring and are the reason that infected individuals
historically were considered outcasts in many cultures. Although human-to-
human transmission is the primary source of infection, three other species can
carry and (rarely) transfer M. leprae to humans: chimpanzees, mangabey
monkeys, and nine-banded armadillos. The disease is termed a chronic
granulomatous disease, similar to tuberculosis, because it produces
inflammatory nodules (granulomas) in the skin and nerves over time.

What is the history of leprosy (Hansen's disease)?

Unfortunately, the history of leprosy and its interaction with man is one of
suffering and misunderstanding. The newest health research suggests that at
least as early as 4000 B.C. individuals had been infected with M. leprae, while
the first known written reference to the disease was found on Egyptian papyrus in
about 1550 B.C. The disease was well recognized in ancient China, Egypt, and
India, and there are several references to the disease in the Bible. Because the
disease was poorly understood, very disfiguring, slow to show symptoms, and
had no known treatment, many cultures thought the disease was a curse or
punishment from the gods. Consequently, leprosy was left to be "treated" by
priests or holy men, not physicians.

Since the disease often appeared in family members, some people thought it
was hereditary. Other people noted that if there was little or no contact with
infected individuals, the disease did not infect others. Consequently, some
cultures considered infected people (and occasionally their close relatives) as
"unclean" or as "lepers" and ruled they could not associate with uninfected
people. Often infected people had to wear special clothing and ring bells so
uninfected people could avoid them.
The Romans and the Crusaders brought the disease to Europe, and the
Europeans brought it to the Americas. In 1873, Dr. Hansen discovered bacteria
in leprosy lesions, suggesting leprosy was an infectious disease, not a hereditary
disease or a punishment from the gods. However, patients with the disease were
still ostracized by many societies and cared for only at missions by religious
personnel. Patients with leprosy were encouraged or forced to live in seclusion
up to the 1940s, even in the United States (for example, the leper colony on
Molokai, Hawaii, that was established by a priest, Father Damien and another
colony established at Carville, La.), often because no effective treatments were
available to patients at that time.

Because of Hansen's discovery of M. leprae, efforts were made to find

treatments that would stop or eliminate M. leprae. In the early 1900s to about
1940, oil from Chaulmoogra nuts was used with questionable efficacy by injecting
it into patients' skin. At Carville in 1941, promin, a sulfone drug, showed efficacy
but required many painful injections. Dapsone pills were found to be effective in
the 1950s, but soon (1960s-1970s), M. leprae developed resistance to dapsone.
Fortunately, drug trials on the island of Malta in the 1970s showed that a three-
drug combination (dapsone, rifampicin [Rifadin], and clofazimine [Lamprene])
was very effective in killing M. leprae. This multi-drug treatment (MDT) was
recommended by the World Health Organization (WHO) in 1981 and remains,
with minor changes, the therapy of choice. MDT, however, does not alter the
damage done to an individual by M. leprae before MDT is started.

Currently, there are several areas (India, East Timor) of the world where the
WHO and other agencies (for example, the Leprosy Mission) are working to
decrease the number of clinical cases of leprosy and other diseases such
as rabies and schistosomiasis that occur in remote regions. Although health
researchers hope to eliminate leprosy like smallpox, endemic (meaning prevalent
or embedded in a region) leprosy makes complete eradication unlikely. In the
U.S., leprosy has occurred infrequently but is considered endemic in Texas,
Louisiana, Hawaii, and the U.S. Virgin Islands by some investigators.

Leprosy is often termed "Hansen's disease" by many clinicians in an attempt to

have patients forgo the stigmas attached to being diagnosed with leprosy.

What causes leprosy?

Leprosy is caused mainly by Mycobacterium leprae, a rod-shaped bacillus that is

an obligate intracellular (only grows inside of certain human and animal cells)
bacterium. M. leprae is termed an "acid fast" bacterium because of its chemical
characteristics. When special stains are used for microscopic analysis, it stains
red on a blue background due to mycolic acid content in its cell walls. The Ziehl-
Neelsen stain is an example of the special staining techniques used to view the
acid-fast organisms under the microscope.

Currently, the organisms cannot be cultured on artificial media. The bacteria take
an extremely long time to reproduce inside of cells (about 12-14 days as
compared to minutes to hours for most bacteria). The bacteria grow best at 80.9
F-86 F, so cooler areas of the body tend to develop the infection. The bacteria
grow very well in the body's macrophages (a type of immune system cell) and
Schwann cells (cells that cover and protect nerve axons). M. leprae is genetically
related to M. tuberculosis (the type of bacteria that cause tuberculosis) and other
mycobacteria that infect humans. As with malaria, patients with leprosy produce
anti-endothelial antibodies (antibodies against the lining tissues of blood
 vessels), but the role of these antibodies in these diseases is still under
investigation.

In 2009, investigators discovered a new Mycobacteriumspecies, M. lepromatosis,

which causes diffuse disease (lepromatous leprosy). This new species
(determined by genetic analysis) was found in patients located in Mexico and the
Caribbean islands.

What are the risk factors for leprosy?

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People at highest risk are those who live in the areas where leprosy is endemic
(parts of India, China, Japan, Nepal, Egypt, and other areas) and especially
those people in constant physical contact with infected people. In addition, there
is some evidence that genetic defects in the immune system may cause certain
people to be more likely to become infected (region q25 on chromosome 6).
Additionally, people who handle certain animals that are known to carry the
bacteria (for example, armadillos, African chimpanzee, sooty mangabey, and
cynomolgus macaque) are at risk of getting the bacteria from the animals,
especially if they do not wear gloves while handling the animals.

What are leprosy early symptoms and signs?

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Unfortunately, the early signs and symptoms of leprosy are very subtle and occur
slowly (usually over years). The symptoms are similar to those that may occur
with syphilis, tetanus, and leptospirosis. The following are the major signs and
symptoms of leprosy:

 Numbness (among the first symptoms)

 Loss of temperature sensation (among the first symptoms)
 Touch sensation reduced (among the first symptoms)
 Pins and needles sensations (among the first symptoms)
 Pain (joints)
 Deep pressure sensations are decreased or lost
 Nerve injury
 Weight loss
 Blisters and/or rashes
 Ulcers, relatively painless
 Skin lesions of hypopigmented macules (flat, pale areas of skin that lost
color)
 Eye damage (dryness, reduced blinking)
 Large ulcerations (later symptoms and signs)
 Hair loss (for example, loss of eyebrows)
 Loss of digits (later symptoms and signs)
 Facial disfigurement (for example, loss of nose) (later symptoms and
signs)

This long-term developing sequence of events begins and continues on the

cooler areas of the body (for example, hands, feet, face, and knees).

Are there different forms (classifications) of leprosy?

There are multiple forms of leprosy described in the literature. The forms of
leprosy are based on the person's immune response to M. leprae. A good
immune response can produce the so-called tuberculoid form of the disease, with
limited skin lesions and some asymmetric nerve involvement. A poor immune
response can result in the lepromatous form, characterized by extensive skin and
symmetric nerve involvement. Some patients may have aspects of both forms.
Currently, two classification systems exist in the medical literature: the WHO
system and the Ridley-Jopling system. The Ridley-Jopling system is composed
of six forms or classifications, listed below according to increasing severity of
symptoms:

 Indeterminate leprosy: a few hypopigmented macules; can heal

spontaneously, this form persists or advances to other forms
 Tuberculoid leprosy: a few hypopigmented macules, some are large and
some become anesthetic (lose pain sensation); some neural involvement
in which nerves become enlarged; spontaneous resolution in a few years,
persists or advances to other forms
 Borderline tuberculoid leprosy: lesions like tuberculoid leprosy but smaller
and more numerous with less nerve enlargement. This form may persist,
revert to tuberculoid leprosy, or advance to other forms
 Mid-borderline leprosy: many reddish plaques that are asymmetrically
distributed, moderately anesthetic, with regional adenopathy (swollen
lymph nodes). The form may persist, regress to another form, or progress
 Borderline lepromatous leprosy: many skin lesions with macules (flat
lesions) papules(raised bumps), plaques, and nodules, sometimes with or
without anesthesia; the form may persist, regress or progress to
lepromatous leprosy
  Lepromatous leprosy: Early lesions are pale macules (flat areas) that are
diffuse and symmetric. Later many M. leprae organisms can be found in
them. Alopecia (hair loss) occurs. Often patients have no eyebrows or
eyelashes. As the disease progresses, nerve involvement leads to
anesthetic areas and limb weakness. Progression leads to aseptic
necrosis (tissue death from lack of blood to area), lepromas (skin nodules),
and disfigurement of many areas, including the face. The lepromatous
form does not regress to the other less severe forms. Histoid leprosy is a
clinical variant of lepromatous leprosy that presents with clusters of
histiocytes (a type of cell involved in the inflammatory response) and a
grenz zone (an area of collagen separating the lesion from normal tissue)
seen in microscopic tissue sections.

The Ridley-Jopling classification is used globally in evaluating patients in clinical

studies. However, the WHO classification system is more widely used. It has only
two forms or classifications of leprosy. The 2009 WHO classifications are simply
based on the number of skin lesions as follows:

 Paucibacillary leprosy: skin lesions with no bacilli (M. leprae) seen in a skin
smear
 Multibacillary leprosy: skin lesions with bacilli (M. leprae) seen in a skin
smear

However, the WHO further modifies these two classifications with clinical criteria
because "of the non-availability or non-dependability of the skin-smear services.
The clinical system of classification for the purpose of treatment includes the use
of number of skin lesions and nerves involved as the basis for grouping leprosy
patients into multibacillary (MB) and paucibacillary (PB) leprosy." Investigators
state that up to about four to five skin lesions constitutes paucibacillary leprosy,
while about five or more constitutes multibacillary leprosy.

Multidrug therapy (MDT) with three antibiotics (dapsone, rifampicin, and

clofazimine) is used for multibacillary leprosy, while a modified MDT with two
antibiotics (dapsone and rifampicin) is recommended for paucibacillary leprosy
and composes most current treatments today (see treatment section below).
Paucibacillary leprosy usually includes indeterminate, tuberculoid, and borderline
tuberculoid leprosy from the Ridley-Jopling classification, while multibacillary
leprosy usually includes the double (mid-) borderline, borderline lepromatous,
and lepromatous leprosy.

How is leprosy transmitted? Is leprosy contagious?

Researchers suggest that M. leprae are spread person to person by nasal

secretions or droplets. However, the disease is not highly contagious like the flu.
They speculate that infected droplets reach other peoples' nasal passages and
begin the infection there. Some investigators suggest the infected droplets can
infect others by entering breaks in the skin. M. leprae apparently cannot infect
intact skin. Rarely, humans get leprosy from the few animal species mentioned
above. Occurrence in animals makes it difficult to eradicate leprosy from endemic
sources. Routes of transmission are still being researched for leprosy. Recent
genetic studies have demonstrated that several genes (about seven) are
associated with an increased susceptibility to leprosy. Some researchers now
conclude that susceptibility to leprosy may be partially inheritable.

How do health care professionals diagnose leprosy?

 The majority of cases of leprosy are diagnosed by clinical findings, especially
since most current cases are diagnosed in areas that have limited or no
laboratory equipment available. Hypopigmented patches of skin or reddish skin
patches with loss of sensation, thickened peripheral nerves, or both clinical
findings together often comprise the clinical diagnosis. Skin smears or biopsy
material that show acid-fast bacilli with the Ziehl-Neelsen stain or the Fite stain
(biopsy) can diagnose multibacillary leprosy, or if bacteria are absent, diagnose
paucibacillary leprosy. Other tests can be done, but most of these are done by
specialized labs and may help a clinician to place the patient in the more detailed
Ridley-Jopling classification and are not routinely done (lepromin test, phenolic
glycolipid-1 test, PCR, lymphocyte migration inhibition test or LMIT). Other tests
such as CBC test, liver function tests, creatinine test, or a nerve biopsy may be
done to help determine if other organ systems have been affected.

What health care specialists treat leprosy?

Although pediatricians and primary care doctors usually follow patients with
leprosy, initial diagnosis and treatment is often done in consultation with
infectious disease specialists, dermatologists, neurologists, and/or
immunologists. Some patients may require consultation with a surgeon to restore
some functions of movement and/or do cosmetic repairs.

What is the treatment for leprosy?

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The majority of cases (mainly clinically diagnosed) are treated with antibiotics.
The recommended antibiotics, their dosages, and length of time of administration
are based on the form or classification of the disease and whether or not the
patient is supervised by a medical professional. In general, paucibacillary leprosy
is treated with two antibiotics, dapsone and rifampicin, while multibacillary
leprosy is treated with the same two plus a third antibiotic, clofazimine. Usually,
the antibiotics are given for at least six to 12 months or more to cure the disease.

Antibiotics can treat paucibacillary leprosy with little or no residual effects on the
patient. Multibacillary leprosy can be kept from advancing, and living M.
leprae can be essentially eliminated from the person by antibiotics, but the
damage done before antibiotics are administered is usually not reversible.
Recently, the WHO suggested that single-dose treatment of patients with only
one skin lesion with rifampicin, minocycline (Minocin), or ofloxacin(Floxin) is
effective. Studies of other antibiotics are ongoing. Each patient, depending on the
above criteria, has a schedule for their individual treatment, so treatment
schedules should be planned by a clinician knowledgeable about that patient's
initial diagnostic classification.

Steroid medications have been used to minimize pain and acute inflammation
with leprosy; however, controlled trials showed no significant long-term effects on
nerve damage.

The role for surgery in the treatment of leprosy occurs after medical treatment
(antibiotics) has been completed with negative skin smears (no detectable acid-
fast bacilli) and is often only needed in advanced cases. Surgery is individualized
for each patient with the goal to attempt cosmetic improvements and, if possible,
to restore limb function and some neural functions that were lost to the disease.
Some people in the United States may be treated in special clinics run by the
National Hansen's Disease Program.

As is the case with many diseases, home remedies can be found in the lay
literature. For example, a paste made from the neem plant, Hydrocotyle, also
known as Cantella asiatica, and even aromatherapy with frankincense have been
suggested. Patients are urged to discuss any home remedies with their physician
before using such methods; often there is little or no scientific data to uphold
these cure claims.

What are the complications of leprosy?

The complications of leprosy depend on how quickly the disease is diagnosed
and effectively treated. Very few complications occur if the disease is treated
early enough, but the following is a list of complications that can occur when
diagnosis and treatment is either delayed or started late in the disease process:

 Sensory loss (usually begins in extremities)

 Permanent nerve damage (usually in extremities)
 Muscle weakness
 Progressive disfigurement (for example, eyebrows lost, disfigurement of
the toes, fingers, and nose)

In addition, the sensory loss causes people to injure body parts without the
individual being aware that there is an injury. This can lead to additional
problems such as infections and poor wound healing.

Is it possible to prevent leprosy?

Prevention of contact with droplets from nasal and other secretions from patients
with untreated M. leprae infection is currently the most effective way to avoid the
disease. Treatment of patients with appropriate antibiotics stops the person from
spreading the disease. People who live with individuals who have untreated
leprosy are about eight times as likely to develop the disease, because
investigators speculate that family members have close proximity to infectious
droplets. Leprosy is not hereditary, but recent findings suggest susceptibility to
the disease may have a genetic basis.

Many people get exposed to leprosy throughout the world, but the disease in not
highly contagious. Researchers suggest that most exposures result in no
disease, and further studies suggest that susceptibility may be based, in part, by
a person's genetic makeup. In the U.S., there are about 200-300 new cases
diagnosed per year, with most coming from exposures during foreign travel. The
majority of worldwide cases are found in the tropics or subtropics (for example,
Brazil, India, and Indonesia). The WHO reports about 500,000 to 700,000 new
cases per year worldwide, with curing of about 14 million cases since 1985.

There is no commercially available vaccine available to prevent leprosy.

However, there are reports that using BCG vaccine alone, the BCG vaccine
along with heat-killed M. leprae organisms, and other preparations may be
protective, help to clear the infection or possibly shorten treatment. Except for
BCG being obtainable in some countries, these other preparations are not readily
available.

Animals (chimpanzees, mangabey monkeys, and nine-banded armadillos) rarely

transfer M. leprae to humans. Nonetheless, handling such animals in the wild is
not advised. These animals are a source for endemic infections.
What is the prognosis of leprosy?
The prognosis of leprosy varies with the stage of the disease when first
diagnosed and treated. For example, early diagnosis and treatment limits or
prevents tissue damage so the person has a good outcome. However, if the
patient's infection has progressed to more advanced disease, the complications
listed above can markedly affect the patient's lifestyle, and thus the condition has
a fair to poor prognosis.

https://www.medicinenet.com/leprosy/article.htm

Hansen’s disease (also known as leprosy) is an infection caused by slow-growing bacteria

called Mycobacterium leprae. It can affect the nerves, skin, eyes, and lining of the nose (nasal
mucosa). With early diagnosis and treatment, the disease can be cured. People with Hansen’s
disease can continue to work and lead an active life during and after treatment.

Leprosy was once feared as a highly contagious and devastating disease, but now we know it
doesn’t spread easily and treatment is very effective. However, if left untreated, the nerve damage
can result in crippling of hands and feet, paralysis, and blindness.

What is Hansen’s Disease?

Hansen’s disease (also known as leprosy) is an infection caused by bacteria called Mycobacterium
leprae. These bacteria grow very slowly and it may take up to 20 years to develop signs of the
infection.

The disease can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). The bacteria
attack the nerves, which can become swollen under the skin. This can cause the affected areas to
lose the ability to sense touch and pain, which can lead to injuries, like cuts and burns. Usually, the
affected skin changes color and either becomes:

 lighter or darker, often dry or flaky, with loss of feeling, or

 reddish due to inflammation of the skin.

If left untreated, the nerve damage can result in paralysis of hands and feet. In very advanced cases,
the person may have multiple injuries due to lack of sensation, and eventually the body
may reabsorb the affected digits over time, resulting in the apparent loss of toes and fingers. Corneal
ulcers and blindness can also occur if facial nerves are affected. Other signs of advanced Hansen’s
disease may include loss of eyebrows and saddle-nose deformity resulting from damage to the nasal
septum.

Early diagnosis and treatment usually prevent disability that can result from the disease, and people
with Hansen’s disease can continue to work and lead an active life. Once treatment is started, the
person is no longer contagious. However, it is very important to finish the entire course of treatment
as directed by the doctor.

Each year, about 150 to 250 people in the United States and 250,000 around the world get the
illness. In the past, Hansen’s disease was feared as a highly contagious, devastating disease, but
now we know that it’s hard to spread and it’s easily treatable once recognized. Still, a lot of stigma
and prejudice remains about the disease, and those suffering from it are isolated and discriminated
against in many places where the disease is seen. Continued commitment to fighting the stigma
through education and improving access to treatment will lead to a world free of this completely
treatable disease.

How do people get Hansen’s disease?

It is not known exactly how Hansen’s disease spreads between people. Scientists currently think it
may happen when a person with Hansen’s disease coughs or sneezes, and a healthy person
breathes in the droplets containing the bacteria. Prolonged, close contact with someone with
untreated leprosy over many months is needed to catch the disease.

You cannot get leprosy from a casual contact with a person who has Hansen’s disease like:

 Shaking hands or hugging

 Sitting next to each other on the bus
 Sitting together at a meal
Hansen’s disease is also not passed on from a mother to her unborn baby during pregnancy and it is
also not spread through sexual contact.

Due to the slow-growing nature of the bacteria and the long time it takes to develop signs of the
disease, it is often very difficult to find the source of infection.

In the southern United States, some armadillos are naturally infected with the bacteria that cause
Hansen’s disease.

In the southern United States, some armadillos are naturally infected with the bacteria that cause
Hansen’s disease in people and it may be possible that they can spread it to people. However, the
risk is very low and most people who come into contact with armadillos are unlikely to get Hansen’s
disease.

For general health reasons, avoid contact with armadillos whenever possible. If you had a contact
with an armadillo and are worried about getting Hansen’s disease, talk to your healthcare provider.
Your doctor will follow up with you over time and perform periodic skin examinations to see if you
develop the disease. In the unlikely event that you have Hansen’s disease, your doctor can help you
get treatment.
Who Is at Risk?
In the U.S., Hansen’s disease is rare. Around the world, as many as 2 million people are
permanently disabled as a result of Hansen’s disease.

Overall, the risk of getting Hansen’s disease for any adult around the world is very low. That’s
because more than 95% of all people have natural immunity to the disease.

You may be at risk for the disease if you live in a country where the disease is widespread.
Countries that reported more than 1,000 new cases of Hansen’s disease to WHO between 2011 and
2015 are:

 Africa: Democratic Republic of Congo, Ethiopia, Madagascar, Mozambique, Nigeria, United

Republic of Tanzania
 Asia: Bangladesh, India, Indonesia, Myanmar, Nepal, , Philippines, Sri Lanka
 Americas: Brazil

The distribution of new leprosy cases by country among 136 countries that reported to WHO in
2015. India reported 127 326 new cases, accounting for 60% of the global new leprosy cases; Brazil,
reported 26 395 new cases, representing 13% of the global new cases; and Indonesia reported 17
202 new cases, 8% of the global case load. No other countries reported >10 000 new cases. Eleven
countries reported between 1000 and 10 000 cases: from Africa, the Democratic Republic of Congo,
Ethiopia, Madagascar, Mozambique, Nigeria and United Republic of Tanzania; from Southeast Asia,
Bangladesh, Myanmar, Nepal and Sri Lanka; and from Western Pacific, the Philippines. Collectively,
these countries reported 19 069 new cases, 14% of all new cases globally. The remaining 10 286
new cases (5%) were reported by 92 countries. Thirty countries reported zero new cases. Ninety-two
countries did not report, several of which are known to have cases of leprosy. Source: Courtesy of
WHO

Symptoms mainly affect the skin, nerves, and mucous membranes (the soft, moist areas just inside
the body’s openings).

The disease can cause skin symptoms such as:

A large, discolored lesion on the chest of a person with Hansen’s disease.

 Discolored patches of skin, usually flat, that may be numb and look faded (lighter than the skin
around)
 Growths (nodules) on the skin
 Thick, stiff or dry skin
 Painless ulcers on the soles of feet
 Painless swelling or lumps on the face or earlobes
 Loss of eyebrows or eyelashes

Symptoms caused by damage to the nerves are:

 Numbness of affected areas of the skin

 Muscle weakness or paralysis (especially in the hands and feet)
 Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
 Eye problems that may lead to blindness (when facial nerves are affected)

Enlarged nerves below the skin and dark reddish skin patch overlying the nerves affected by the
bacteria on the chest of a patient with Hansen’s disease. This skin patch was numb when touched.

Symptoms caused by the disease in the mucous membranes are:

 A stuffy nose
 Nosebleeds

Since Hansen’s disease affects the nerves, loss of feeling or sensation can occur. When loss of
sensation occurs, injuries such as burns may go unnoticed. Because you may not feel the pain that
can warn you of harm to your body, take extra caution to ensure the affected parts of your body are
not injured.

If left untreated, the signs of advanced leprosy can include:

 Paralysis and crippling of hands and feet

 Shortening of toes and fingers due to reabsorption
 Chronic non-healing ulcers on the bottoms of the feet
 Blindness
 Loss of eyebrows
 Nose disfigurement

Other complications that may sometimes occur are:

 Painful or tender nerves

 Redness and pain around the affected area
 Burning sensation in the skin

Diagnosis and Treatment

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How is the disease diagnosed?

Hansen’s disease can be recognized by appearance of patches of skin that may look lighter or
darker than the normal skin. Sometimes the affected skin areas may be reddish. Loss of feeling in
these skin patches is common. You may not feel a light touch or a prick with a needle.

To confirm the diagnosis, your doctor will take a sample of your skin or nerve (through a skin or
nerve biopsy) to look for the bacteria under the microscope and may also do tests to rule out other
skin diseases.
How is the disease treated?
Hansen’s disease is treated with a combination of antibiotics. Typically, 2 or 3 antibiotics are used at
the same time. These are dapsone with rifampicin, and clofazimine is added for some types of the
disease. This is called multidrug therapy. This strategy helps prevent the development of antibiotic
resistance by the bacteria, which may otherwise occur due to length of the treatment.

Treatment usually lasts between one to two years. The illness can be cured if treatment is completed
as prescribed.

If you are treated for Hansen’s disease, it’s important to:

 Tell your doctor if you experience numbness or a loss of feeling in certain parts of the body or in
patches on the skin. This may be caused by nerve damage from the infection. If you have
numbness and loss of feeling, take extra care to prevent injuries that may occur, like burns and
cuts.
 Take the antibiotics until your doctor says your treatment is complete. If you stop earlier, the
bacteria may start growing again and you may get sick again.
 Tell your doctor if the affected skin patches become red and painful, nerves become painful or
swollen, or you develop a fever as these may be complications of Hansen’s disease that may
require more intensive treatment with medicines that can reduce inflammation.

If left untreated, the nerve damage can result in paralysis and crippling of hands and feet. In very
advanced cases, the person may have multiple injuries due to lack of sensation, and eventually the
body may reabsorb the affected digits over time, resulting in the apparent loss of toes and fingers.
Corneal ulcers or blindness can also occur if facial nerves are affected, due to loss of sensation of
the cornea (outside) of the eye. Other signs of advanced leprosy may include loss of eyebrows and
saddle-nose deformity resulting from damage to the nasal septum.

Antibiotics used during the treatment will kill the bacteria that cause leprosy. But while the treatment
can cure the disease and prevent it from getting worse, it does not reverse nerve damage or
physical disfiguration that may have occurred before the diagnosis. Thus, it is very important that the
disease be diagnosed as early as possible, before any permanent nerve damage occurs.
https://www.cdc.gov/leprosy/health-care-workers/index.html