Hansen’s disease (also known as leprosy) is a complex infectious condition caused by a slow-growing bacterium named Mycobacterium leprae. Approximately 95% of people naturally have immunity and it is not a highly contagious disease. People at an early stage of Hansen’s disease can prevent disability with treatment and lead to an active work life.
Mycobacterium leprae bacteria that cause leprosy or Hansen’s disease primarily infect the skin and can affect other tissues such as nasal mucosa, eyes, and testes. However, if it’s left untreated, in advanced cases person may have multiple disabilities due to loss of sensation. Hansen’s disease can remain stigma and discrimination against due to historical misconceptions about the disease in many places because of that continued commitment to fighting the stigma through education and awareness about the treatment is important.
It involves the peripheral nerves and if left untreated, nerve damage can lead to paralysis of hands, feet or blindness and corneal ulcers if facial nerves are affected. Early detection and treatment are important to prevent these disabilities.
Hansen’s disease, often mistaken for the biblical condition of leprosy, is a multifaceted, long-lasting infectious disease brought about by the bacterium Mycobacterium leprae. This bacterium was identified by Dr. Gerhard H.A. Hansen in Norway back in 1873.
Different skin lesions that are typically encountered in leprosy can be divided into the following subsections:
- Tuberculoid Leprosy (TT): This manifests as big hypopigmented or erythematous lesions with distinct demarcation and elevated edges. The plaque presentation was found to be scaly.
- Borderline tuberculoid (BT): It refers to macules that have a “target” appearance in lesions. This disease usually affects one side of the body, in which a higher number of lesions are present than tuberculoid leprosy. These forms of lesions are classified as “paucibacillary” according to WHO.
- Mid-borderline (BB): This illness, referred to as “multibacillary,” is most like BT leprosy or border-lepromatous in appearance, with “punched out” lesions. In this central portion are largely anesthetic.
- Lepromatous leprosy on the borderline (BL): In this instance, lesions are erythematous macules, nodules, or papules that do not exhibit a recognizable pattern of physical appearance on the body. Even if there are normal skin patches present, the lesions are dispersed and difficult to identify.
Skin lesions are usually the first clinical manifestation observed. Signs & Symptoms include:
- Facial Deformities
- Sagging face
- Madarosis – loss of eyebrows
- Buddha’s ears
- Rat bitten ears
- Saddle nose deformities
- Collapsed Pinna
- Leonine Facies.
- Motor Nerve Defects
- Common peroneal n-foot drop
- Post tibial n-claw toes/ hammer toes!
- Facial Palsy
- Radial wrist drop
- Ulnar n-partial claw hand
- Ocular Involvement
- Iris pearls: These are clusters of M.leprae.
- The most common cause is blindness
- Corneal hypoesthesia
- Superficial punctate keratitis- Chalk- like clusters
People with the first sign usually show up on the skin and if they don’t get the right treatment or are left untreated, it can cause permanent damage to the skin, nerves, and other part of the body. There are two main ways to classify the clinical presentation of Hansen’s Disease:
- The Ridley-Jopling system looks at what leprosy looks like, what the tissue samples show, and how many bacteria are present.
- The WHO system looks at the number of skin lesions or the number of bacteria in a skin smear test.
These clinical presentation helps professionals or doctors to understand how severe leprosy is to decide the best treatment. In WHO classification if someone has only one or two skin lesions affected, they’re classified as paucibacillary leprosy and if they have multiple skin lesions affected or high bacteria levels, it’s called multibacillary leprosy.
Depending on the children’s age or whether they have a mild or severe form of the disease World Health Organization WHO recommends a specific treatment therapy. This treatment option involves a combination of three drugs: rifampicin, clofazimine, and dapsone.
For children, the treatment lasts for six months for mild cases (paucibacillary) while for those with more severe cases (multibacillary), it lasts for 12 months. All patients take this treatment once a month under supervision. In patients where the first-line treatment is ineffective, second-line drugs like minocycline, clarithromycin, and ofloxacin may be used.
This multidrug therapy includes preventing resistance to dapsone, reducing the incidence of adverse reactions and risk of recurrence, minimizes the spread of disease. However, the long duration of treatment and logistical challenges can make it difficult for patients to adhere to the treatment regimen.
In conclusion, Leprosy continues to be a major significant global public health issue, emphasizing the importance of all healthcare professionals having a basic understanding of the disease. Aspiring postgraduate students can enhance their knowledge through exceptional resources such as the Dermatology Online e-Lecture Series, which offers comprehensive video lectures by renowned experts like Dr. Rashmi Sarkar and Dr. S. Sachhidanand. This online platform provides an excellent opportunity to learn about dermatology conveniently and effectively.
