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Leprosy is one of the oldest maladies and is well recognized in the oldest civilization of China, Egypt and India as a contagious, mutilating and incurable disease. The humans feared it because it resulted in disfigurement and physical disabilities, which are irreversible. Leprosy is also associated with a lot of stigma and in ancient times the community shunned people affected with leprosy into separate leper colonies

Leprosy is believed to have existed in Egypt as long ago as 4000 BC and in India and Japan earlier than 1000 BC. It is also called as the infectious disease of the East. It later spread to Europe and British Isles and by 13th centaury it reached epidemic proportions.


Leprosy is a chronic infectious disease affecting the skin, eyes, testes, the peripheral nerves and mucosa of the upper respiratory tract but capable of affecting any tissue or organ.

Etiological Agent: Infection by a bacteria called - Mycobacterium leprae.

Gerhard Armauer Hansen discovered M.leprae in 1873 and hence came to be called as Hansen's disease. It was the first bacterium to be identified as a disease-causing agent in man, yet it remains as one of the disease that is least understood. It is prevalent in warm, wet areas in the tropics and subtropics.

Other than humans the bacteria affects armadillos, mangabe monkeys, rabbits and mice.


Leprosy is caused by Mycobacterium leprae, which is an aerobic (oxygen dependant) rod shaped acid-fast bacillus that spreads through droplet infection. It has never been grown in culture media but has been grown in footpads of the nine-banded armadillos. This bacterium has a long incubation period of 5 years in man and multiplies very slowly. Children are more susceptible than adults. Man is the only source of infection. They mainly spread through droplet infection. A large number of bacteria are shed in the nasal secretions and from the superficial lesions and nasal secretions of the multibacillary type of leprosy.


Respiratory tract or skin.
Asymptomatic infections are very common.


Leprosy is classified into several types based on the bacterial load present in the lesions, the extent of skin and nerve involvement and based on the presence of deformities. Several types of classification like Madrid classification, Ridley & Jopling classification Indian Classification, WHO classification , Field Worker's Classification etc.

Based on the 2 commonly used classifications, leprosy is classified into six types based on the clinical features:

The first sign of the disease is the feeling of numbness or loss of sensation for temperature (heat) followed by touch and pain which usually begins at the extremities. The skin lesions appear later during the course of the disease.

-> They are the first type of skin lesions characterized by hypo-pigmented spots.
-> The lesions undergo healing spontaneously


-> A large red patch with well-defined raised borders or a large hypo pigmented asymmetrical lesion.
-> Lesion is dry and hairless
-> Infectivity is minimal at this stage
-> Loss of sensation is seen
-> Nerves become thick followed by loss of function
-> It either progresses to the borderline stage or spontaneously get cured.


-> Characterized by small and numerous skin lesions
-> The disease goes back to the tuberculoid stage or progresses to the next stage.


-> Several small, irregular red lesions are seen
-> Moderate sensory loss is seen
-> It either goes back to the previous stage or progresses to the next


Several lesions such as plaques, macules, papules, and nodules are seen.
Lesions have a characteristic inverted saucer like appearance.

(lepromatous leprosy)


-> Several lesions such as plaques, macules, papules, and nodules are seen.
-> Nasal congestion, discharge and bleeding is seen
-> Inflammation of the leg and ankles


-> Thickening of the dermis (skin) in the forehead and ear lobes
-> Loss of eyebrows and eyelashes
-> Eye defects such as glaucoma and blindness are seen
-> Nodules in the legs break and form ulcers
-> Enlargement of the breast and sterility occurs in the males
-> Internal infection results in the enlargement of the liver and lymph nodes
-> Loss of sensation in the peripheral nerves. Deformation of the fingers and toes results due to painless repeated trauma.


-> Physical examination

-> Skin scrapings:
(which is smeared on the slide and stained with Ziel-Neelsen technique)

-> Biopsy.

-> Lepromin skin test.

( It is positive in case of Tuberculoid type and negative in Lepromatous Leprosy).

-> Antibody detection.

-> Mouse footpad inoculation test

-> Advanced Molecular Testing


Dapsone is the first effective drug against leprosy but the bacteria developed resistance against the drug. Hence in 1970s the scenario shifted from monotherapy to Multiple Drug Therapy (MDT). The drugs used in WHO-MDT are a combination of rifampicin (600mg once a month), clofazimine (300 mg once a month and 50mg daily) and dapsone (100mg daily) for one year for Multibacillary (MB) leprosy patients and rifampicin (600mg once a month),and dapsone (100mg daily) for six months for Paucibacillary leprosy patients. For single skin Paucibacillary lesion single dose of

Rifampicin: 600 mg, Ofloxacin: 400 mg,and Minocycline: 100 mg is given. A minimum follow-up of 5 years is needed after completion of therapy in Multibacillary leprosy and a follow-up of 2 years in case of Puacibacillary cases.MDT is available free of cost from WHO.


-> Dapsone
-> Clofazimine
-> Rifampicin


Rehabilitation is part and parcel of effective leprosy control. Preventing deformities by early detection and prompt treatment is one of the essential steps in Rehabilitation Secondly for those patients who are having deformities either special accessories or corrective surgical procedures have to be undertaken.

Social and vocational Rehabilitation are integral components for the leprosy patients to lead a life of dignity.


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