World Leprosy Day

What is Leprosy?

Leprosy is a chronic, progressive bacterial infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves of the extremities, the skin, the lining of the nose, and the upper respiratory tract. Leprosy is also known as Hansen’s disease.

Hansen’s disease produces skin ulcers, nerve damage, and muscle weakness. If it isn’t treated, it can cause severe disfigurement and significant disability.

Hansen’s disease is one of the oldest diseases in recorded history. The first known written reference to Hansen’s disease is from around 600 B.C.

What are the symptoms of Hansen’s disease?

The main symptoms of Hansen’s disease include:

• muscle weakness
• numbness in the hands, arms, feet, and legs
• skin lesions

The skin lesions result in decreased sensation to touch, temperature, or pain. They don’t heal, even after several weeks. They’re lighter than your normal skin tone or they may be reddened from inflammation.

How does Hansen’s disease spread?

The bacterium Mycobacterium leprae causes Hansen’s disease. It’s thought that Hansen’s disease spreads through contact with the mucosal secretions of a person with the infection. This usually occurs when a person with Hansen’s disease sneezes or coughs.

The disease isn’t highly contagious. However, close, repeated contact with an untreated person for a longer period of time can lead to contracting Hansen’s disease.

The bacterium responsible for Hansen’s disease multiplies very slowly. The disease has an average incubation period (the time between infection and the appearance of the first symptoms) of five yearsTrusted Source, according to the World Health Organization (WHO).

Symptoms may not appear for as long as 20 years.

What are the types of Hansen’s disease?

There are three systems for classifying Hansen’s disease.

1. Tuberculoid Hansen’s disease vs. lepromatous Hansen’s disease vs. borderline Hansen’s disease

The first system recognizes three types of Hansen’s disease: tuberculoid, lepromatous, and borderline. A person’s immune response to the disease determines which of these types of Hansen’s disease they have:

• In tuberculoid Hansen’s disease, the immune response is good. A person with this type of infection only exhibits a few lesions. The disease is mild and only mildly contagious.
• In lepromatous Hansen’s disease, the immune response is poor. This type also affects the skin, nerves, and other organs. There are widespread lesions, including nodules (large lumps and bumps). This form of disease is more contagious.
• In borderline Hansen’s disease, there are clinical features of both tuberculoid and lepromatous Hansen’s disease. This type is considered to be between the other two types.

2. World Health Organization (WHO) classification

WHO categorizesTrusted Source the disease based on the type and number of affected skin areas:

• The first category is paucibacillary. There are five or fewer lesions and no bacterium detected in the skin samples.
• The second category is multibacillary. There are more than five lesions, the bacterium is detected in the skin smear, or both.

3. Ridley-Jopling classification

Clinical studies use the Ridley-Jopling system. It has five classifications based on severity of symptoms.

Classification	Symptoms	Disease response
Tuberculoid Hansen’s disease	A few flat lesions, some large and numb; some nerve involvement	Can heal on its own, persist, or may progress to a more severe form
Borderline tuberculoid Hansen’s disease	Lesions similar to tuberculoid but more numerous; more nerve involvement	May persist, revert to tuberculoid, or advance to another form
Mid-borderline Hansen’s disease	Reddish plaques; moderate numbness; swollen lymph nodes; more nerve involvement	May regress, persist, or progress to other forms
Borderline lepromatous Hansen’s disease	Many lesions, including flat lesions, raised bumps, plaques, and nodules; more numbness	May persist, regress, or progress
Lepromatous Hansen’s disease	Many lesions with bacteria; hair loss; more severe nerve involvement with peripheral nerve thickening; limb weakness; disfigurement	Doesn’t regress

There’s also a form a Hansen’s disease called indeterminate Hansen’s disease that isn’t included in the Ridley-Jopling classification system. It’s considered to be a very early form of Hansen’s disease where a person will have only one skin lesion that’s just slightly numb to the touch.

Indeterminate Hansen’s disease may resolve or progress further to one of the five forms of Hansen’s disease within the Ridley-Jopling system.

How is Hansen’s disease diagnosed?

Your doctor will conduct a physical exam to look for telltale signs and symptoms of the disease. They’ll also perform a biopsy in which they remove a small piece of skin or nerve and send it to a laboratory for testing.

Your doctor may also perform a lepromin skin test to determine the form of Hansen’s disease. They’ll inject a small amount of Hansen’s disease-causing bacterium, which has been inactivated, into the skin, typically on the upper forearm.

People who have tuberculoid or borderline tuberculoid Hansen’s disease will experience a positive result at the injection site.

How is Hansen’s disease treated?

WHO developed a multidrug therapyTrusted Source in 1995 to cure all types of Hansen’s disease. It’s available free of charge worldwide.

Additionally, several antibiotics treat Hansen’s disease by killing the bacteria that causes it. These antibiotics include:

• dapsone (Aczone)
• rifampin (Rifadin)
• clofazimine (Lamprene)
• minocycline (Minocin)
• ofloxacin (Ocuflux)