Dr Anil Ganjoo
Leprosy or Hansen’s disease is a disease of the lower socio economic populace. It is transmitted through air by close personal contact. It reaches the host through infected aerosol from an infected person and enters the body through the respiratory system.
The bacteria causing the disease are call Mycobacterium leprae which has a predilection for nerves, i.e. it affects the nerves primarily. It gets localized in the nerves of the skin and the limbs and causes inflammation of the same. The nerves thus lose their function and the result is loss of sensation in the area of the skin supplied by that particular nerve. It can also lead to decrease in power of the muscles supplied by the affected nerves.
The disease has a long incubation period and it can take 2 to 7 years for the disease to develop after one has contacted the infection. Conditions that can help the disease to spread include overcrowded and unhygienic environs.
The development of the disease in the infected person depends on the immune status of the individual. Those with a good immune status develop a less virulent disease localized to one or small numbers of nerves in one area of the body. These patients’ disease is called Tuberculoid Leprosy and is usually not infective to others. The other set of patients are the ones who have a poor immune status and can’t fight the disease well and thus have a widespread disease involving many nerves all over the body. This is called Lepromatous Leprosy. These patients have bacteria in their respiratory secretions and are a potential source of infection to others.
Clinically the disease presents in 2 ways. In the Tuberculoid variety the patients present with 1 to few areas of loss of sensation on the skin. These areas may be dry, show decreased pigmentation (are light coloured) or sometimes red and thickened, and may also show loss of hair. The nerve supplying the area may be swollen and enlarged and sometimes painful. The Lepromatous Leprosy presents with more widespread involvement of skin and nerves all over the body. The disease is bilaterally symmetrical and involves the skin and nerves on both sides of the body. The patients present with hypopigmented (light coloured) to red patches on the skin, with or without loss of sensation, all over the body including the face. The nerves are thickened and inflamed symmetrically on both sides of the body. The nerves can be painful also. There can be varying degrees of loss of sensations and power of hands and feet. The loss of sensation can lead to frequent ulcerations due to trauma and burns that are not perceived by the sensation less skin. This frequent trauma can lead to resorption (shortening of fingers and toes)
The Leprosy patients are not generally very ill except when they are in reaction. Reactions can be a good sign in patients undergoing treatment which shows that their disease is improving. They can present with excessive redness and inflammation of the affected areas and swelling and pain in the affected nerves. Reaction can also be seen in Lepromatous Leprosy patients whose disease is improving or deteriorating. This reaction is called Erythema Nodosum Leprosum and can be associated with profound illness. The patient can have fever, malaise, painful swellings all over the body and painful joints.
Although the disease requires prolonged treatment but it is 100 % curable. The treatment is to be continued for 6 months for Tuberculoid Leprosy and for 1 year for Lepromatous Leprosy. The Lepromatous patients who are very infectious to others before the start of treatment become non infective within the first few weeks of start of treatment. The patients showing above signs should contact their dermatologist at the earliest for complete cure of their disease.
(The author is HoD Department of Dermatologist and Senior Consultant Saroj Super Speciality Hospital)
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