Leprosy, or Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. The disease primarily affects the skin and peripheral nerves, resulting in skin lesions, numbness, and muscle weakness. It is transmitted through prolonged and close contact with an infected person but is not highly contagious. Leprosy has been stigmatized throughout history, leading to social exclusion and discrimination against those affected. However, with early diagnosis and treatment with multi-drug therapy, the disease can be cured, and the associated disabilities can be prevented. Anti- Leprosy Campaign carries out disease control activities to ensure detection of cases early.
Leprosy may have varying clinical presentations. As the bacterium prefers a cooler temperature certain areas of the skin like the scalp are less likely to be involved.
The commonest skin lesion is the light coloured patch with reduced sensation, which is usually single. These patches may be dry with loss of hairs within the lesion. Sometimes leprosy may present with many light coloured patches that may look like “aluham”.
When the disease spreads within the body there may be several skin coloured or reddish patches, which are raised from the surface of the skin.
The disease is spread by patients who have changes in the face. These changes include thickening of the skin of the face, nodules in the forehead, earlobes and the chin and blockage of the nose leading to a nasal stuffiness and a nasal voice. These patients are very likely to suffer from numbness of hands and feet.
Leprosy may also present with thickening of nerves at the neck or elbows or numbness or weakness of muscles due to damage to major nerves. Such nerve damage may later result in non-healing wounds in the hands and feet if left untreated.
Diagnosis of leprosy involves a combination of clinical examination and laboratory tests. The clinical study includes a thorough examination of the skin and nerves. Slit Skin Smear is used in confirming the diagnosis as well as in follow up. A skin biopsy can also be done to support the diagnosis. Early diagnosis is crucial for the effective treatment and prevention of disability.
Effective management of leprosy requires early diagnosis, prompt initiation of appropriate multidrug therapy, and regular follow-up. Treatment is provided free of charge by government dermatology clinics in Sri Lanka. Multidrug therapy (MDT) is the standard treatment, which includes a combination of antibiotics. MDT can be used safely in pregnant and breast feeding mothers and also in children. MDT has been used for over 40 years effectively and safely.
Treatment duration depends on the type and severity of the disease. Those with less severe disease are treated with 2 drugs for 6 months while more extensive disease is treated with 3 drugs for 12 months. Awareness programs are also conducted to ensure patient treatment adherence and reduce the stigma associated with the disease.
Leprosy can cause significant disabilities if left untreated. The disabilities are caused by nerve damage and include muscle weakness, loss of sensation, and deformities of the hands and feet. Early detection and treatment can prevent disabilities. Disability prevention is critical to leprosy management and involves regular monitoring, physiotherapy, and other rehabilitation services. The government provides free access to specialized management services for leprosy-related disabilities.