India accounts for 58% of total leprosy patients around the world. The reason being lack of awareness of the disease. DR Ritupurna Dash tells you ways to identify and treat it
Leprosy is an infectious disease which is also known as Hansen’s Disease. It is caused by a bacteria called Mycobacterium leprae and mainly affects the skin, peripheral nerves and the eyes. The initial symptoms usually are loss of sensation on the affected area of the skin along with discolored patches on the body or painless ulcers which if left untreated can lead to permanent disability like disfigurement of hands and feet, loss of sensation and blindness.
Leprosy is still one of the most misunderstood diseases in the world and hence poses many unique challenges in controlling and eliminating it. Leprosy was declared as ‘eradicated disease’ in 2005, but India still accounts for the maximum number of people to be affected by leprosy in the world; 58 per cent of the total people globally suffering from leprosy are in India. The disease is still widespread in many parts of the country due to lack of awareness, socio-economic myths and beliefs and associated stigma. These commonly lead to delayed care seeking and treatment completion. Further major concerns include prevalence of leprosy among children, undetected new cases and problems with leprosy integration.
In India, people with leprosy frequently present in late stages of disease progression and usually with eye complications leading to blindness.
Symptoms
One of the initial symptoms can be excessive nose bleeding and a stuffy nose without reason. Numbness, loss of temperature/touch sensation, pins and needles sensations, joint pain, decreased or lost deep pressure sensations, nerve injury, weight loss, blisters and/ or rashes, large ulcers (relatively painless), discolored skin patches, eye damage (dryness, reduced blinking), loss of eyebrows, loss of digits and disability, and facial disfigurement are some of the other commonly encountered problems.
The complications of leprosy depend on how early it is detected and effectively treated. Very few complications occur if treatment is initiated early enough. However, if treatment is delayed or discontinued mid way, complications may manifest. Sensory loss (usually beginning in the extremities), permanent nerve damage (usually, again, in the extremities), muscle weakness and progressive disfigurement (for example, eyebrows lost, disfigurement of the toes, fingers, and nose) are some common complications. In addition, the sensory loss causes people to injure body parts without the individual being aware that there is an injury. This can lead to further problems such as infections, poor wound healing and ulcers. A condition called erythema nodosum leprosum (tender skin nodules accompanied by other symptoms like fever, joint pain, neuritis, and edema) is also encountered as a complication needing immediate attention.
Risks of transmission
Leprosy has low transmission rate. However, people of all age groups and gender are susceptible to develop leprosy. Transmission occurs only with close contact with the one suffering from leprosy. The risks also are raised to up to 10 times to develop and spread leprosy. The major concerns of developing and transmitting new cases of leprosy especially in India include — reduced functioning of the immune system due to malnutrition, related illness or ailments and at times, due to genetic conditions.
It is very crucial to develop a comprehensive approach to combat Leprosy. Some of these include educating public through awareness campaigns, programmes on sustainable livelihood and skill training for the affected people (economic mainstreaming), interventions to counter social stigma (social mainstreaming).
The writer is MBBS MD (Dermatology, Leprosy & Venereology)
Treatment
It is important to understand the symptoms and immediately consult the skin specialist for diagnosis. Based on the level of disease progression, the doctor will prescribe the appropriate treatment. The medication and condition varies from person to person and can only be planned with the initial diagnosis.
Treatment is quite effective if started in the initial stages, and hence timely diagnosis and treatment is important. Steroids may be given to minimise pain and acute inflammation. Majority of the cases can be treated with antibiotics only.
Depending on the stage, the dosage of the medication may vary. According to WHO, Leprosy is classified into two types — paucibacillary and multibacillary, and hence the medications also differ. The course of the medication is usually for six to 12 months to completely cure the condition.
Upon successful course completion, the bacteria is completely eliminated from the person’s body and further disease progression and damage is averted. But, the damage undergone already is not reversible with medications.
In such conditions, surgical intervention may be helpful to restore functions like movement related issues, neurological prolems, and cosmetic repair. Surgery is usually individualised and can restore the limb and neural functions lost in the course of the ailment.