About leprosy (hansen's disease)

What is leprosy (hansen's disease)?

Leprosy is a slowly developing, progressive disease that damages the skin and nervous system.

  • Leprosy is caused by an infection with Mycobacterium leprae or M. lepromatosis bacteria.
  • Early symptoms begin in cooler areas of the body and include loss of sensation.
  • Signs of leprosy are painless ulcers, skin lesions of hypopigmented macules (flat, pale areas of skin), and eye damage (dryness, reduced blinking). Later, large ulcerations, loss of digits, skin nodules, and facial disfigurement may develop.
  • The infection is thought to be spread person to person by nasal secretions or droplets. Leprosy is rarely transmitted from chimpanzees, mangabey monkeys, and nine-banded armadillos to humans by droplets or direct contact.
  • Susceptibility to getting leprosy may be due to certain human genes.
  • Antibiotics are used in the treatment of leprosy.

What is leprosy?

Leprosy is a disease caused by the bacteria Mycobacterium leprae, which causes damage to the skin and the peripheral nervous system. The disease develops slowly (from six months to 40 years!) and results in skin lesions and deformities, most often affecting the cooler places on the body (for example, eyes, nose, earlobes, hands, feet, and testicles). The skin lesions and deformities can be very disfiguring and are the reason that infected individuals historically were considered outcasts in many cultures. Although human-to-human transmission is the primary source of infection, three other species can carry and (rarely) transfer M. leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The disease is termed a chronic granulomatous disease, similar to tuberculosis, because it produces inflammatory nodules (granulomas) in the skin and nerves over time.

What is the history of leprosy (Hansen's disease)?

Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. The newest research suggests that at least as early as 4000 B.C. individuals had been infected with M. leprae, while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. The disease was well recognized in ancient China, Egypt, and India, and there are several references to the disease in the Bible. Because the disease was poorly understood, very disfiguring, slow to show symptoms, and had no known treatment, many cultures thought the disease was a curse or punishment from the gods. Consequently, leprosy was left to be "treated" by priests or holy men, not physicians.

Since the disease often appeared in family members, some people thought it was hereditary. Other people noted that if there was little or no contact with infected individuals, the disease did not infect others. Consequently, some cultures considered infected people (and occasionally their close relatives) as "unclean" or as "lepers" and ruled they could not associate with uninfected people. Often infected people had to wear special clothing and ring bells so uninfected people could avoid them.

The Romans and the Crusaders brought the disease to Europe, and the Europeans brought it to the Americas. In 1873, Dr. Hansen discovered bacteria in leprosy lesions, suggesting leprosy was an infectious disease, not a hereditary disease or a punishment from the gods. However, patients with the disease were still ostracized by many societies and cared for only at missions by religious personnel. Patients with leprosy were encouraged or forced to live in seclusion up to the 1940s, even in the U.S. (for example, the leper colony on Molokai, Hawaii, that was established by a priest, Father Damien and another colony established at Carville, La.), often because no effective treatments were available to patients at that time.

Because of Hansen's discovery of M. leprae, efforts were made to find treatments that would stop or eliminate M. leprae. In the early 1900s to about 1940, oil from Chaulmoogra nuts was used with questionable efficacy by injecting it into patients' skin. At Carville in 1941, promin, a sulfone drug, showed efficacy but required many painful injections. Dapsone pills were found to be effective in the 1950s, but soon (1960s-1970s), M. leprae developed resistance to dapsone. Fortunately, drug trials on the island of Malta in the 1970s showed that a three-drug combination (dapsone, rifampicin [Rifadin], and clofazimine [Lamprene]) was very effective in killing M. leprae. This multi-drug treatment (MDT) was recommended by the WHO in 1981 and remains, with minor changes, the therapy of choice. MDT, however, does not alter the damage done to an individual by M. leprae before MDT is started.

Currently, there are several areas (India, East Timor) of the world where the WHO and other agencies (for example, the Leprosy Mission) are working to decrease the number of clinical cases of leprosy and other diseases such as rabies and schistosomiasis that occur in remote regions. Although researchers hope to eliminate leprosy like smallpox, endemic (meaning prevalent or embedded in a region) leprosy makes complete eradication unlikely. In the U.S., leprosy has occurred infrequently but is considered endemic in Texas, Louisiana, Hawaii, and the U.S. Virgin Islands by some investigators.

Leprosy is often termed "Hansen's disease" by many clinicians in an attempt to have patients forgo the stigmas attached to being diagnosed with leprosy.

What are the symptoms for leprosy (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.

What are the causes for leprosy (hansen's disease)?

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 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 years, according to the World Health Organization (WHO).

Symptoms may not appear for as long as 20 years.

According to the New England Journal of Medicine, an armadillo native to the southern United States and Mexico can also carry the disease and transmit it to humans.

What are the treatments for leprosy (hansen's disease)?

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)

Your doctor will likely prescribe more than one antibiotic at the same time.

They may also want you to take an anti-inflammatory medication such as aspirin (Bayer), prednisone (Rayos), or thalidomide (Thalomid). The treatment will last for months and possibly up to 1 to 2 years.

You should never take thalidomide if you are or may become pregnant. It can produce severe birth defects.

What are the risk factors for leprosy (hansen's disease)?

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.


Is there a cure/medications for leprosy (hansen's disease)?

The overall outlook is better if your doctor diagnoses the Hansen’s disease promptly before it becomes severe. Early treatment prevents further tissue damage, stops the spread of the disease, and prevents serious health complications.

The outlook is typically worse when diagnosis occurs at a more advanced stage, after an individual has significant disfigurement or disability. However, proper treatment is still necessary to prevent any further body damage and prevent the spread of the disease to others.

There may be permanent medical complications despite a successful course of antibiotics, but your physician will be able to work with you to provide proper care in order to help you cope with and manage any residual conditions.

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