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Dermatologic Manifestations of Leprosy

Background

Leprosy is a chronic granulomatous disease principally affecting the skin and peripheral nervous system. Leprosy is caused by infection with Mycobacterium leprae. Although much improved in the last 25 years, knowledge of the pathogenesis, course, treatment, and prevention of leprosy continues to evolve. The skin lesions and deformities were historically responsible for the stigma attached to leprosy. However, even with proper multidrug therapy (MDT), the extensive sensory and motor damage can result in the deformities and disabilities associated with leprosy. See the image below.

Hands with Z-thumbs, clawing, contractures, and sh

Hands with Z-thumbs, clawing, contractures, and shortening of fingers due to repetitive injury and healing. Ho Chi Minh City, Vietnam. (Courtesy of D. Scott Smith, MD)

The earliest description of leprosy comes from India around 600 BCE. Leprosy was then described in the Far East around 400 BCE. In the fourth century, leprosy was imported into Europe, where its incidence peaked in the 13th century. Leprosy has now nearly disappeared from Europe. Affected immigrants spread leprosy to North America.

Armauer Hansen discovered M leprae in Norway in 1873. M leprae was the first bacillus to be associated with human disease. Despite this discovery, leprosy was not initially thought to be an infectious disease.

In 2008, the discovery of a new cause of leprosy, Mycobacterium lepromatosis, was announced. Genetically, M leprae and M lepromatosis are very similar, but M lepromatosis causes the diffuse form of lepromatous leprosy found in Mexico and the Caribbean.
 

Leprosy is included among the Neglected Tropical Diseases as designated by the World Health Organization.
In 2016, the WHO released a 5-year global leprosy strategy, running through 2020, to “strengthen government ownership, coordination, and partnership; stop leprosy and its complications, and to stop discrimination and promote inclusion.”

Other articles on leprosy include Leprosy Neuropathy and Leprosy.

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