Leprosy/Hansen's disease

Patients may report areas of numbness or tingling, particularly in extremities, alongside hypopigmented or red skin patches that may be painless. Weakness, reduced sensation to temperature, or a history of previous infections may also be noted. Some patients could recall potential exposure in areas where leprosy is endemic. 

Risk factors include prolonged exposure in endemic areas, genetic predisposition, and co-existing immune deficiencies, particularly in immunocompromised individuals. 

Physical examination often reveals hypopigmented or reddish patches, particularly on the face, limbs, or torso, with diminished sensation. Skin thickening, especially around the face and earlobes, along with nerve enlargement, is common. Advanced cases may show muscle weakness, claw-like hand deformities, or bone loss. 

In 1982, the World Health Organization published a recommendation to use dapsone and rifampin for tuberculoid leprosy and in combination with clofazimine for managing the lepromatous disease. 2018 WHO guidelines now advise for uniform MDT with the recommendations for treatment from 1998 still maintained.  MDT typically extends from 6-12 months based on severity.

This entails administering three drugs: rifampin, dapsone, and clofazimine, to individuals despite the classified type.

• Tuberculoid disease: dapsone (100 mg daily) with rifampicin (600 mg daily) for 12 months

• Lepromatous disease: dapsone, rifampicin, and clofazimine (50 mg daily) for 24 months

 It's essential to educate patients on adherence to prevent relapses and monitor for side effects such as anemia or gastrointestinal discomfort. For nerve pain or inflammation, corticosteroids can provide relief, but monitoring for adverse effects is crucial. Surgical intervention might be necessary in cases of deformities or nerve compression.

Leprosy is treatable, but delayed care can result in irreversible nerve damage, leading to disability or deformity. Early MDT can prevent progression and complications, ensuring a positive prognosis.