To mark the World Leprosy Day on January 30, dermatologists talk about the rise in cases getting reported and Leprosy not being a stigma anymore. It is preventable and curable, says Sangeeta Yadav

What is Leprosy

Leprosy commonly referred to as Hansen’s disease is caused by a slow-growing bacteria called Mycobacterium Leprae (M Leprae). The disease causes pale coloured disfiguring skin sores, lumps or bumps around the body that do not go away after several weeks or months. It also causes nerve damage leading to loss of feeling in the arms and legs and muscle weakness.

About 1,80,000 people worldwide are infected with leprosy, according to the World Health Organization, most of them in Africa and Asia. “Leprosy is getting reported at a large level in India as it is no more a stigma. That is because of wide awareness campaigns and the Government is making every effort to eradicate leprosy and provide free treatment. It is quite rampant in UP, Bihar, North- East regions and South India. In the rural area, it is still a stigma but people do realise that the disease is curable. Earlier people suffering from leprosy used to feel scared to come out in public thinking they would be debarred from the society. But that is not the case anymore. When it gets diagnosed, people feel a little shock initially but not out of society. Also, with the help of multi-drug therapy which we start quite early, you make them non-infectious so that it doesn’t get spread to other people who come in contact with him. Earlier patients don’t go to take the free medicine and follow-up checkup because they think there will have to stand in a long cue but that has also changed with various volunteers working towards awareness and eradication and ensuring better care,” Dr RK Joshi, senior consultant, dermatologist, Indraprastha Apollo Hospitals, New Delhi.

Early diagnosis

In India, leucoderma and Vitiligo are quite common which is light pigmented patches on the skin and many a times, people take it lightly. But once you spot the white patch on the body, do early detection on your body. “When anybody is coming with one of two white patches on their skin, there are three simple ways is test the cutaneous sensation in the affected area. First, pain test in which you take a needle and test the area for any kind of pain. Second, thermal in which use the heat or cold object to feel the sensation. Third, touch. If you feel the numbness and not a complete loss of sensation, next step is the skin biopsy. Another simple test is Tzenck or skin smear test in which you take a needle, scrape the skin up to the dermal area, take the tissues on the slide and look at the microscope,” Dr Joshi says.

Causes

One catches leprosy only if they come into close and repeated contact with nose and mouth droplet from someone with untreated leprosy. Children are more likely to get leprosy than adults. The condition primarily affects the peripheral nerves and secondarily involves skin and certain other tissues/organs, in particular, the eyes, mucous of the nasal and upper respiratory tract," Dr Sakshi Srivastava, Consultant Dermatologist, Jaypee Hospital, Noida.

Symptoms

The bacteria usually takes about three to five years for symptoms to appear after coming into contact with the bacteria. “The time between contact with the bacteria and the appearance of symptoms is called the incubation period. The symptoms include disfigurement, hair loss particularly on the eyebrows and eyelashes, muscle weakness, permanent nerve damage in the arms and legs leading inability to use them. It also causes deep cracks on the feet also known as fisher feet, sudden pain in the joints, fever, and hypo-pigmented skin lesions with severe ulceration. It also causes chronic nasal congestion, nosebleeds, and collapse of the nasal septum, inflammation of the iris of the eye and glaucoma. Leprosy can also pilot erectile dysfunction and infertility, and kidney failure,” Dr Srivastava tells you.

Prevention

Screening of the patient’s family for leprosy is a must. “Trained nurses and technician can go and do the proper examination of the skin of the patient’s family member and if anybody has a slight chance of getting it, they should be immediately brought up into our awareness. If they think that there is any patch or spotted a doubtful region, bring the patient to our doctor and get the skin smear test done,” Dr Joshi says.

One has to have good nutrition to develop strong immunity. “To improve immunity for other diseases also, protein is the best. Second, be in a hygienic environment. Overcrowding is a problem in spreading the disease. In those circumstances, people have to take stern action to make sure that these people are been treated. Educating from the school level is the most for the eradication of the disease. This is not a stigma but rather like any other infection and is preventable and curable. You can also be treated at home also,” Dr Joshi opines.

Challenges

The problem of developing resistance. It is a dire situation but we have certain medicines which help in this treatment that is given only the disease doesn’t get controlled as we expected to be.
Complete treatment: There should be some kind of mechanism to ensure the leprosy patient gets registered, take proper treatment and coming for the follow-up until fully cured so that leprosy doesn’t reoccur.
Patients can get lepra reaction. This is a sort of allergic reaction that takes place when the parasite dies down because of the improvement of the immunity. The immunological reaction takes place in your system which makes the affected area red, inflamed and painful and can affect the joints, face difficulty to walk and can develop arthritis. They can get hepatic involvement, eye involvement or nerve involvement and if the reaction is very bad, it can develop hand drop or foot drop due to paralysis. To diagnose and recognise lepra reaction, biopsy is the best way and thalidomide medicine is very helpful in this case. If a patient comes with lepra reaction, there are chances of misdiagnosed with cutaneous vasculitis, panniculitis with fat inflammation or blood vessel inflammation. To prevent from getting lepra reaction, we have to continue the anti-leprosy treatment maybe in a small dose till the patient gets completely cured.

Types & treatment

Tuberculoid leprosy: The patient gets cured within six months to nine months. Use of dapsone but make sure G6PD is not deficit otherwise it can lead to anaemic. Those allergic to sulfa should be very careful or avoid dapsone
Borderline leprosy: It takes two to three years to get cured. Along with dapsone, the patient is given rifampin once a month.
Lepromatous leprosy: This advanced stage of leprosy takes five to seven years to cure depending on the reaction. We give dapsone, rifampin and clofazamine and gradually reduce it to once a month. “As soon as we diagnose the patient with leprosy, we immediately start the multi-drug therapy that makes them non-infectious so that it doesn’t get spread to other people who come in contact with him. Within a week, the patient becomes non-infectious. The treatment is a combined approach nowadays between dermatology, neurology and plastic surgery,” Dr Joshi.

Leprosy is curable