Leprosy

At the hospital I've been learning a lot about leprosy, so I thought I'd share a bit with you. Here is how you diagnose leprosy (to tell if someone actually has leprosy or not):

Talk to the Person - Questions to Ask

How long has the skin patch been there?
How did it start?
Has it changed?
(usually patches appear slowly)
Do the patches itch?
Is there pain?
(usually not itchy and not painful)
Do you have unusual sensations in your hands or feet, like numbness, tingling, or burning?
(if there are unusual sensations, it could be leprosy)
Have your hands or feet become weaker?
Do you have problems holding or lifting things, or moving your hands and feet?
(loss of strength can be a sign of leprosy)
Have you experienced any social problems?
(often people are ostracized if they have some disability due to leprosy)

Examine the Skin
1) Look for skin patches (may be reddish in color, raised edges)
2) Look for thickening of skin, that is shiny and dry to the touch
3) Look for nodules or lumps (indicates a serious infection)

Can you see the two patches on this man's face?

Test the Feeling in the Skin Patches
1) Patient should close their eyes first
2) Touch the skin patch with cotton wool or the tip of a pen
3) Patient should point to where you touched them
4) Touch normal skin to make sure that the patient understands
(if they cannot feel anything in the skin patch, then they have leprosy)

These patches are a bit easier to see. Note the hard, raised edges and discoloration...

Feel the Nerves
1) Ulnar Nerve
a. Hold the patient’s hand as if you were shaking hands with them
b. Feel around the back of the elbow, from outside in
c. Palpate the nerve between two points of bone and compare to other arm
d. If nerve feels larger in one arm, then it is enlarged
2) Peroneal Nerve
a. Feel for nerve on the outside of the leg, just below the knee
b. Also feel for the nerve behind the knee (it comes from behind the knee and curves around the fibula)
c. If nerve feels larger in one leg, then it is enlarged
3) Enlarged nerves may indicate leprosy
4) Also check for painful nerves (this could indicate leprosy reaction)

Examine Hands and Feet
1) Check for loss of sensation, pain, numbness
2) Look for deformities (bone absorption, degeneration, etc.)
3) Look for ulcers, lesions, wounds
4) Check for dry, cracked skin
(all these could indicate reduced sensation as a result of leprosy)

Most patients in the ward are either ulcer patients, or else they are in reaction (which I'll write about later)

Skin Smear

- if necessary, have a skin smear taken to check for bacteria from leprosy patches

These are shoes that we give to leprosy patients to protect their feet and distribute their weight evenly.

This is the medication we give to treat leprosy. Once they start taking the medicine, they are no longer contagious. This medicine will cure a person completely from their leprosy!