Leprosy and the Skin: How Dermatology Plays a Crucial Role in Diagnosis

Dr. Aswathy Saschandran,
Dermatologist
Apollo Adlux Hospital, Angamaly

Leprosy, also known as Hansen’s disease, remains one of the oldest diseases known to humankind. Despite being curable and manageable today, it continues to pose public health challenges due to the stigma associated with it and the delay in diagnosis. As dermatologists, we play a pivotal role in identifying and managing this disease in its early stages, especially since the skin is often the first organ to exhibit symptoms.

The Link Between Leprosy and the Skin:
Mycobacterium leprae and Mycobacterium lepromatosis cause leprosy. The bacteria primarily affect the skin, peripheral nerves, upper respiratory tract, and eyes. Since skin changes are usually the earliest signs of the disease, dermatologists are often the first line of defense in identifying leprosy.

The disease manifests as hypopigmented or reddish patches on the skin, often accompanied by sensory loss. Early symptoms may be subtle, and patients might initially ignore them, attributing the changes to less concerning conditions like fungal infections or eczema. This is where our expertise as dermatologists becomes critical.

The Crucial Role of Dermatology
Dermatology contributes significantly to early detection and treatment of leprosy. Some of the key responsibilities include:

Identifying Early Signs: Dermatologists are trained to differentiate between leprosy patches and other skin conditions. We conduct simple sensory tests to detect nerve involvement, which is a hallmark of the disease.
Skin Biopsy and Laboratory Testing: When clinical suspicion arises, a skin biopsy and slit-skin smear test confirms the diagnosis.

Ensuring Early Treatment: Prompt diagnosis allows for early initiation of multidrug therapy (MDT), preventing disability and transmission.
Raising Awareness: Dermatologists are uniquely positioned to educate patients and the community, dispelling myths about leprosy and emphasizing that it is neither highly contagious nor a curse.

Leprosy in India:
India shoulders a significant global burden of leprosy cases, with over 60% of the world’s cases being reported here. According to the National Leprosy Eradication Programme (NLEP) Annual Report 2022-2023, India recorded 1,19,468 new cases, reflecting a detection rate of 8.9 per 100,000 population. While the numbers indicate a decline compared to previous decades, delayed diagnosis and stigma remain critical barriers to complete eradication.

Alarmingly, about 7% of these cases involve children under 15, highlighting ongoing transmission. Furthermore, Grade 2 disabilities (severe deformities) were seen in 4% of new cases, underscoring the need for heightened awareness and early intervention.

The Skin’s Silent Testimony
Leprosy presents with a diverse spectrum of skin manifestations, ranging from subtle hypopigmentation to more pronounced lesions.

Hypopigmented macules: These are areas of skin that have lost their normal color, appearing lighter than the surrounding skin. They may be flat or slightly raised and often lack sensation.  

Infiltrated plaques: These are raised, thickened areas of skin that may have a reddish or brownish hue. They can occur anywhere on the body but are commonly seen on the face, ears, and limbs.
Madarosis: This refers to the loss of eyebrows and eyelashes, a characteristic feature of leprosy.  

Importance of Early Diagnosis
Early diagnosis and treatment of leprosy are crucial for several reasons:

Prevention of Disabilities: Prompt treatment can prevent nerve damage and the development of debilitating complications such as hand deformities, foot ulcers, and blindness.  

Improved Quality of Life: Early treatment can significantly improve the quality of life for individuals with leprosy by minimizing physical limitations and social stigma.  
Prevention of Transmission: Early treatment reduces the risk of transmission to others

Combating Leprosy Together
On this Leprosy Day, it is essential to reflect on how far we’ve come and the road ahead. Dermatologists, in collaboration with public health workers, play a crucial role in bridging the gap between detection and cure. Early intervention can prevent complications and deformities, allowing individuals affected by leprosy to lead normal, fulfilling lives.

It is also our responsibility to tackle the societal stigma surrounding leprosy. By normalizing conversations and providing accurate information, we can foster an environment of acceptance and support.

Together, let us aim to make leprosy a relic of the past—not just a medical condition but a story of triumph over ignorance and discrimination.