Leprosy: Symptoms & Treatment

Leprosy, also called Hansen's disease, is caused by Mycobacterium leprae, a slow-growing bacteria. It is a chronic infectious disease predominantly affecting the peripheral nerves, skin, eyes, nasal mucosa, and lining of the upper respiratory tract. Leprosy is generally not life-threatening but can cause significant physical and emotional suffering. There is no definitive cause of leprosy. The disease is believed to be spread through contact with an infected person or animal through nasal secretions, saliva, or other bodily fluids. The condition is curable if detected and treated timely during the initial stages. 

It can affect people of all age groups. In leprosy, the bacterial attack swells the nerves, which can cause the affected areas to lose sensation. This loss of ability to sense touch and pain results in injuries like cuts and burns. A color change occurs in the affected area, and the skin either becomes lighter or darker (often dry or flaky) or reddish due to inflammation of the skin.

Sign and Symptoms of Leprosy

Leprosy mainly affects skin, nerves, and mucous membranes with characteristic symptoms like:

Skin symptoms:

• A large, discolored lesion on a person with Hansen's disease's chest.
• Patches of discolored skin - usually flat, painless, and appear faded.
• Skin nodules
• Skin that is thick, stiff, or dry.
• Painless foot ulcers
• Painless lumps on the face or earlobes 
• Loss of eyebrow 

Nerve symptoms:

• Numbness in the affected skin areas.
• Peripheral muscle atrophy or paralysis.
• Nerves that have grown in size (especially those around the elbow and knee and in the sides of the neck)
• Loss of vision if facial nerves are involved.
• Enlarged nerves beneath the skin and a numb, dark reddish skin patch overlying the nerves affected by the bacteria.

Mucous membrane symptoms:

• Congested nose
• Nosebleed

Physical Deformities and Complications Associated with Leprosy

Leprosy is known to cause a range of physical deformities and other clinical complications. The most common deformities caused by leprosy are nerve damage, muscle paralysis, and loss of sensation in the hands, feet, and face. In addition, leprosy can cause thickening of the skin, loss of eyebrows, and a flattening of the nose. It can also cause facial disfigurement, the loss of fingers and toes, and permanent scarring. A few other deformities associated with leprosy are:

• Complete or partial clawing of the hand 
• Inability to close eyes ( Lagophthalmos)
• Alopecia
• Erectile dysfunction

In addition to physical deformities, leprosy can cause various clinical complications. These include blindness, nerve damage, chronic ulcerations in the sole, severe infections, and even renal failure. People with leprosy may also experience psychological issues such as depression, anxiety, and social ostracism.

Diagnosis of Leprosy

The diagnosis of leprosy is based on the type of skin lesions, the degree of nerve involvement, and the presence of acid-fast bacilli (AFB) in the smear. The skin lesions of leprosy are usually pale, flat patches of skin known as macules. They may be accompanied by a sensation loss known as anesthetic leprosy. In addition, leprosy can cause nodules, plaques, and other skin lesions. 

The initial step in the diagnosis of leprosy is a physical examination. During the examination, the doctor will look for skin lesions and check for signs of nerve involvement. The doctor may also take a skin biopsy to confirm the presence of leprosy. The next step in the diagnosis is a laboratory test known as a skin smear. This is done by taking a swab from the affected area and sending it to a laboratory for testing. The test is used to look for the presence of acid-fast bacilli (AFB). If the test is positive, then the diagnosis of leprosy is confirmed. The physician may also perform a lepromin skin test to determine the type of Hansen's disease. 

Treatment of Leprosy

Once leprosy has been diagnosed, treatment should be started immediately. Treatment involves a combination of antibiotics and anti-inflammatory drugs. The most commonly used antibiotics are dapsone, rifampicin, and clofazimine. These drugs are usually taken for 12 months or longer. In addition, other drugs, such as thalidomide and immunosuppressants, may also be prescribed to reduce inflammation and improve the patient's quality of life. 

Surgery may sometimes be required to restore function and improve physical appearance. In addition, occupational therapy, physical therapy, and emotional support can help people with leprosy to cope with their physical deformities and emotional distress.

Regular follow-up visits to the doctor are essential to ensure that the patient is responding to the treatment. 

The Bottom Line

Leprosy is a serious condition that can cause disfigurement and disability if not treated early. Physical deformities, psychological issues, and other complications can be life-altering. It is crucial to be aware of the signs and symptoms of leprosy and seek medical attention if any of them are present. Early treatment prevents further tissue damage, the spread of the disease, and severe health complications, thus allowing the patient to live an active life.