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 Think of leprosy with any unexplained peripheral lesion or any chronic skin lesion which fails to respond
to “conventional” treatment
 Because leprosy has a strong social stigma attached, confidentiality is especially important
May present with:
 Skin lesions, nerve pain, numbness and tingling, weakness, ulcers and injuries
 Areas of skin discolouration may appear coppery on dark skin and pink on fair skin
 Limb deformities and chronic ulceration and scarring on hands and feet as a result of trauma to
areas with loss of sensation
 Weakness, particularly the small joints in the hands and feet
 Sharp shooting pains in the legs, arms, body and face is rare
 Eye pain and worsening vision
 Lagophthalmos (unable to completely close eye properly)
 Loss of eyebrows and lashes
Immediate management – not applicable
Clinical assessment:
 Obtain a complete patient history – enquire specifically about the presence and duration of lesions,
nerve pain, numbness and tingling, weakness, ulcers and injuries, eye pain and worsening vision.
Ascertain previous possible exposure to leprosy
 Perform standard clinical observations
 Perform physical examination
inspect and palpate the entire skin surface for lesions which can include macules, papules,
plagues, nodules and urticaria –like lesions. Patches may appear coppery on dark skin and pink
on fair skin. (Sometimes the only lesions maybe on the buttocks)
 skin lesions:
o good immunity (tuberculoid leprosy)
 pale patches (never totally white), may be red in light skins, single or few in number, have a well
demarcated edge (which may be a little thickened), are anaesthetic to light touch (eg. with a
piece of cotton wool), destruction of hair follicles and loss of sweat and sebaceous glands
o little or no immunity (lepromatous leprosy)
 skin lesions are multiple, often a coppery or violaceous colour, not anaesthetic, and teeming with
leprosy bacilli on skin smears
 nerve damage:
o peripheral neuropathy affects most commonly the ulnar nerve, which is thickened, and may
be tender in the groove behind the elbow. Damage to the ulnar nerve leads to anaesthesia
first, then to loss of motor function, then to deformity in the area of the 5 th and 4th fingers
o other nerves involved are:
 posterior tibial (anaesthesia of the sole of the foot)
 common peroneal (foot-drop)
 radial (wrist drop)
 facial (lagophthalmus, i.e. inability to close the eye fully)
 trigeminal (leading to corneal anaesthesia)
o nerve damage affects both sensory and motor functions (sensation is more often the first to
 the nose (lepromatous leprosy):
o mucoid discharge, containing countless bacteria
o ulceration of the mucosa may occur
o there may be destruction of the septa and adjacent bone
 the eyes (lepromatous leprosy):
o iritis, corneal scarring
 other lesions:
o swelling of infected lymph glands which may breakdown and discharge
o testicular atrophy
 Consult MO
 Untreated acute reactions can cause functional loss that can become irreversible very rapidly (within
hours or days)
 Multi-dose therapy (MDT) of diagnosed cases is the key to achieving cure in the individual and
breaking the cycle of transmission. MDT consists of three drugs: - dapsone, rifampicin and
 Public Health Unit will provide advice on contact tracing of household / family members
Follow up:
 Ensure patient is compliant with medications. Involve family members as much as possible
 It is vital to teach the patient to avoid injury, mainly burns of the hands and friction damage to the feet
due to loss of sensation. Encourage the wearing of suitable footwear
 Ensure the patient receives regular long term follow up. Reinforce to patient and family members that
the patient should present if they have any sudden or increasing weakness/numbness or skin trouble
 All patients with Leprosy require life long follow up
Referral / Consultation:
 Consult MO on all occasions if leprosy is suspected
 Consult Public Health Unit for advice and support on Leprosy and contact tracing