by Gloria S. Akande

Created on: September 09, 2009   Last Updated: September 11, 2009

Leprosy is a chronic granulomatous infection first described by G.A. Hansen in 1873 but has been known since 600 A.D. Leprosy or Hansen's disease is caused by the organism mycobacterium leprae. The disease is a highly visible, affecting the skin and nerves with lesions involving the cooler areas of the skin. The lesions can be debilitating and the disease has had a large impact with social and psychological stigma associated with it. The disease historically was feared to be highly contagious, and patients were banished from contact with others and put in leprosy colonies and sanitariums.

Leprosy is currently classified by the World Health Organization according to the number of lesions present and the number of organisms which may be present on the examination of a slide smeared with material from a lesion as paucibacillary (few bacilli) leprosy or multibacillary (many bacilli) leprosy. About 150 cases of leprosy per year are diagnosed in the United States today. In the past, most of the cases were in the Texas, Florida, Louisiana, and in California. However, now instead of cases being clustered in port cities, new cases are being reported in Iowa and the Midwest. These reported cases are in the immigrant worker population. Doctors are now being advised to raise their index of suspicion for leprosy in patients with skin lesions and to have an increased awareness of the disease which was once rare.

Leprosy is rarely fatal. It involves the skin with lesions which may be reddened and hypopigmented with loss of sensation. The lesions may be plaque-like or raised with annular or serpinginous borders and may occur on the face, buttocks and legs and arms. Patients may develop leonine, lion-like appearance of the face. The eye may also be involved. The skin and its sweat glands and hair follicles are destroyed as the disease progresses. It is not uncommon for the nose to be involved. Lymph nodes in the armpit and groin may be involved. Damage occurs with the involvement of nerves and a clawed hand deformity occurs along with clawed toes. There may be a foot drop with loss of sensory and motor functions.

Leprosy is not highly transmissible as once thought. It can be treated easily without loss of function when caught early. Leprosy is treated based on the disease type. Paucibacillary disease is treated for one year with dapsone, 100 mg per day and rifampin, 600 mg per day. Multibacillary disease is treated for two years with dapsone and rifampin at the same dosages and with an additional drug, clofazimine, 50 mg per day. This treatment cures the disease. Patients have to be followed for up to 10 years after treatment, since 15% may have hypersensitivity reactions to the medications.

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