• What is leprosy?

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

• What causes leprosy?
• What are the symptoms and signs of leprosy?
• Are there different forms (classifications) of leprosy?
• How is leprosy transmitted?
• How is leprosy diagnosed?
• How is leprosy treated?
• How is leprosy prevented?
• Where can I find more information on leprosy?
• Leprosy (Hansen's Disease) At A Glance

What is leprosy?

Leprosy is a disease caused by the bacteria Mycobacterium leprae that 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 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 because it
produces inflammatory nodules (granulomas) in the skin and nerves over time.
 Picture of a person with leprosy (Hansen's disease)

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 (studies are ongoing to prove this by
genetic analysis), 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. 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 hereditary 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, and at Carville, La.), often because
no effective treatments were available. 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 needed many painful injections. Dapsone pills were found to be effective in
the 1950s, but soon (1960s-70s), 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, 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.

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 causes leprosy?

Leprosy is caused by Mycobacterium leprae, a rod-shaped bacillus that is an obligate

intracellular (only grows inside of certain human and animal cells) bacterium. M.
leprae is termed an "acid fast" bacterium because of its chemical characteristics. When
special stains are used for microscopic analysis, it stains red on a blue background due
to mycolic acid content in its cell walls. The Ziel-Nielsen stain is an example of the
special staining techniques used to view the acid-fast organisms under the microscope.
Currently, the organisms cannot be cultured on artificial media. The bacteria take an
extremely long time to reproduce inside of cells (about 12-14 days as compared to
minutes to hours for most bacteria). The bacteria grow best at 80.9 F-86 F, so cooler
areas of the body tend to develop the infection. The bacteria grow very well in the
body's macrophages and Schwann cells (cells that cover and protect nerve axons). M.
leprae is genetically related to M.tuberculosis (the type of bacteria that cause
tuberculosis) and other mycobacteria that infect humans. As with malaria, patients with
leprosy produce anti-endothelial antibodies (antibodies against the lining tissues of
blood vessels), but the role of these antibodies in these diseases is still under
investigation.

What are the symptoms and signs of leprosy?

Unfortunately, the early signs and symptoms of leprosy are very subtle and occur slowly
(usually over years). Numbness and loss of temperature sensation (cannot sense very
hot or cold temperatures) are some of the first symptoms that patients experience. As
the disease progresses, the sensation of touch, then pain, and eventually deep
pressure are decreased or lost. Signs that occur, such as relatively painless ulcers, skin
lesions of hypopigmented macules (flat, pale areas of skin), and eye damage (dryness,
reduced blinking) are experienced before the large ulcerations, loss of digits, and facial
disfigurement develop. This long-time developing sequence of events begins and
continues on the cooler areas of the body (for example, hands, feet, face, and knees).

Are there different forms (classifications) of leprosy?

There are multiple forms of leprosy described in the literature. The forms of leprosy are
based on the person's immune response to M. leprae. A good immune response can
produce the so-called tuberculoid form of the disease, with limited skin lesions and
some asymmetric nerve involvement. A poor immune response can result in the
lepromatous form, characterized by extensive skin and symmetric nerve involvement.
Some patients may have aspects of both forms. Currently, two classification systems
exist in the medical literature: the WHO system and the Ridley-Jopling system. The
Ridley-Jopling system is composed of six forms or classifications, listed below
according to increasing severity of symptoms:

• Indeterminate leprosy: a few hypopigmented macules; can heal spontaneously,

persists or advances to other forms

• Tuberculoid leprosy: a few hypopigmented macules, some are large and some
become anesthetic (lose pain sensation); some neural involvement in which nerves
become enlarged; spontaneous resolution in a few years, persists or advances to
other forms

• Borderline tuberculoid leprosy: lesions like tuberculoid leprosy but smaller and more
numerous with less nerve enlargement; this form may persist, revert to tuberculoid
leprosy, or advance to other forms

• Mid-borderline leprosy: many reddish plaques that are asymmetrically distributed,

moderately anesthetic, with regional adenopathy (swollen lymph nodes); the form
may persist, regress to another form, or progress

• Borderline lepromatous leprosy: many skin lesions with macules (flat lesions)
papules (raised bumps), plaques, and nodules, sometimes with or without
anesthesia; the form may persist, regress or progress to lepromatous leprosy

• Lepromatous leprosy: Early lesions are pale macules (flat areas) that are diffuse and
symmetric; later many M. leprae organisms can be found in them. Alopecia(hair
 loss) occurs; often patients have no eyebrows or eyelashes; as the disease
progresses, nerve involvement leads to anesthetic areas and limb weakness;
progression leads to aseptic necrosis (tissue death from lack of blood to area),
lepromas (skin nodules), and disfigurement of many areas including the face; the
lepromatous form does not regress to the other less severe forms.

The Ridley-Jopling classification is used globally in evaluating patients in clinical

studies. However, the WHO classification system is more widely used; it has only two
forms or classifications of leprosy. The 2009 WHO classifications are simply based on
the number of skin lesions as follows:

• Paucibacillary leprosy: skin lesions with no bacilli (M. leprae) seen in a skin smear

• Multibacillary leprosy: skin lesions with bacilli (M. leprae) seen in a skin smear

However, the WHO further modifies these two classifications with clinical criteria
because "�of the non-availability or non-dependability of the skin-smear services. The
clinical system of classification for the purpose of treatment includes the use of number
of skin lesions and nerves involved as the basis for grouping leprosy patients into
multibacillary (MB) and paucibacillary (PB) leprosy." Investigators state that up to about
four to five skin lesions constitutes paucibacillary leprosy, while about five or more
constitutes multibacillary leprosy.

Mulitdrug therapy (MDT) with three antibiotics (dapsone, rifampicin, and clofazimine) is
used for multibacillary leprosy, while a modified MDT with two antibiotics (dapsone and
rifampicin) is recommended for paucibacillary leprosy. Paucibacillary leprosy usually
includes indeterminate, tuberculoid, and borderline tuberculoid leprosy from the Ridley-
Jopling classification, while multibacillary leprosy usually includes the double (mid-)
borderline, borderline lepromatous, and lepromatous leprosy.

How is leprosy transmitted?

Researchers suggest that M. leprae are spread person to person by nasal secretions or
droplets. They speculate that infected droplets reach other peoples' nasal passages and
begin the infection there. Some investigators suggest the infected droplets can infect
others by entering breaks in the skin. M. leprae apparently cannot infect intact skin.
Rarely, humans get leprosy from the few animal species mentioned above. Routes of
transmission are still being researched for leprosy.

How is leprosy diagnosed?

The majority of cases of leprosy are diagnosed by clinical findings, especially since
most current cases are diagnosed in areas that have limited or no laboratory equipment
available. Hypopigmented patches of skin or reddish skin patches with loss of
sensation, thickened peripheral nerves, or both clinical findings together often comprise
the clinical diagnosis. Skin smears or biopsy material that show acid-fast bacilli with the
Ziel-Nelson stain or the Fite stain (biopsy) can diagnose multibacillary leprosy, or if
bacteria are absent, diagnose paucibacillary leprosy. Other tests can be done, but most
of these are done by specialized labs and may help a clinician to place the patient in the
more detailed Ridley-Jopling classification and are not routinely done (lepromin test,
phenolic glycolipid-1 test, PCR, lymphocyte migration inhibition test or LMIT). Other
tests such as CBC test, liver function tests, creatinine test, or a nerve biopsy may be
done to help determine if other organ systems have been affected.

How is leprosy treated?

The majority of cases (mainly clinically diagnosed) are treated with antibiotics. The
recommended antibiotics, their dosages and length of time of administration are based
on the form or classification of the disease and whether or not the patient is supervised
by a medical professional. In general, paucibacillary leprosy is treated with two
antibiotics, dapsone and rifampicin, while multibacillary leprosy is treated with the same
two plus a third antibiotic, clofazimine. Usually, the antibiotics are given for at least six to
12 months or more. Each patient, depending on the above criteria, has a schedule for
their individual treatment, so treatment schedules should be planned by a clinician
knowledgeable about that patient's initial diagnostic classification.

Antibiotics can treat paucibacillary leprosy with little or no residual effects on the patient.
Multibacillary leprosy can be kept from advancing, and living M. leprae can be
essentially eliminated from the person by antibiotics, but the damage done before
antibiotics are administered is usually not reversible. Recently, the WHO suggested that
single-dose treatment of patients with only one skin lesion with
rifampicin, minocycline (Minocin), orofloxacin (Floxin) is effective. Studies of other
antibiotics are ongoing.

The role for surgery in the treatment of leprosy occurs after medical treatment
(antibiotics) has been completed with negative skin smears (no detectable acid-fast
bacilli) and is often only needed in advanced cases. Surgery is individualized for each
patient with the goal to attempt cosmetic improvements and, if possible, to restore limb
function and some neural functions that were lost to the disease.

How is leprosy prevented?

Prevention of contact with droplets from nasal and other secretions from patients with
untreated M. leprae infection currently is a way to avoid the disease. Treatment of
patients with appropriate antibiotics stops the person from spreading the disease.
People that live with individuals that have untreated leprosy are about eight times as
likely to develop the disease, because investigators speculate that family members
have close proximity to infectious droplets. Leprosy is not hereditary.

Many people get exposed to leprosy throughout the world, but the disease in not highly
contagious; researchers suggest that over 95% of exposures result in no disease. In the
U.S., there are about 200-300 new cases diagnosed per year, with most coming from
exposures during foreign travel. The majority of worldwide cases are found in the tropics
or subtropics (for example, Brazil, India, and Indonesia). The WHO reports about
500,000 to 700,000 new cases per year worldwide, with curing of about 14 million cases
since 1985.

There is no vaccine available to prevent leprosy. Animals (chimpanzees, mangabey

monkeys, and nine-banded armadillos) rarely transfer M. leprae to humans;
nonetheless, handling such animals in the wild is not advised.

Where can I find more information on leprosy?

http://www.cdc.gov/nczved/dfbmd/disease_listing/leprosy_ti.html

http://www.who.int/lep/classification/en/index.html

http://www.who.int/lep/mdt/en/

http://emedicine.medscape.com/article/1104977-overview

http://www3.niaid.nih.gov/topics/leprosy/Understanding/today.htm

Leprosy (Hansen's Disease) At A Glance

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

• Leprosy is caused by an infection with Mycobacterium leprae 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 spread person to person by nasal secretions or droplets.

• Antibiotics are used in the treatment of leprosy.

Leprosy Index

Featured: Leprosy Main Article

Leprosy (Hansen's disease) is a disfiguring disease caused by infection with
 Mycobacterium leprae bacteria. The disease is spread from person to person through
nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of
temperature sensation, painless ulcers, eye damage, loss of digits, and facial
disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of
administration depends upon which form of leprosy the patient has.
Medications
• ofloxacin, Floxin
• dapsone - oral
• clofazimine-oral, Lamprene
• minocycline - injection, Minocin
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• Foot Pain
• Hair Loss
• Alopecia Areata
• Gangrene
View All 9 Leprosy Related Diseases & Conditions »
Doctor's & Expert's Views
• Medicalese: White Patch on the Belly After Death
Procedures & Tests
• Liver Blood Tests
• Creatinine Blood Test
• Complete Blood Count (CBC)
• PCR (Polymerase Chain Reaction)
Health News
• Leprosy Genes Identified
Health Features
• Mental Health: Shame: Secret Ally of Illness
• Biological and Chemical Terror History
• Genital Piercing Becoming More Common
• Psoriasis: More Than Cosmetic
View All 6 Leprosy Health Features »
Tools & References
• Doctor: Checklist to Take To Your Doctor's Appointment
• How to Choose a Doctor
• Doctor: Getting the Most from Your Doctor's Appointment
 Glossary
• Leprosy Glossary

Terms related to Leprosy:

• Hansen's Disease

Leprosy
Leprosy is an infectious disease that has been known since biblical times. It is
characterized by disfiguring skin sores, nerve damage, and progressive debilitation.

Causes
Leprosy is caused by the organism Mycobacterium leprae. It is not very contagious
(difficult to transmit) and has a long incubation period (time before symptoms appear),
which makes it difficult to determine where or when the disease was contracted.
Children are more susceptible than adults to contracting the disease.

Leprosy has two common forms, tuberculoid and lepromatous, and these have been
further subdivided. Both forms produce sores on the skin, but the lepromatous form is
most severe, producing large, disfiguring lumps and bumps ( nodules).
All forms of the disease eventually cause nerve damage in the arms and legs, which
causes sensory loss in the skin and muscle weakness. People with long-term leprosy
may lose the use of their hands or feet due to repeated injury resulting from lack of
sensation.

Leprosy is common in many countries worldwide, and in temperate, tropical, and

subtropical climates. Approximately 100 cases per year are diagnosed in the United
States. Most cases are limited to the South, California, Hawaii, and U.S. island
possessions.

Effective medications exist, and isolation of victims in "leper colonies" is unnecessary.

The emergence of drug-resistant Mycobacterium leprae , as well as increased numbers
of cases worldwide, has led to global concern about this disease.

Symptoms
Symptoms include:

• Skin lesions that are lighter than your normal skin color
○ Lesions have decreased sensation to touch, heat, or pain
○ Lesions do not heal after several weeks to months
• Numbness or absent sensation in the hands, arms, feet, and legs
• Muscle weakness

Exams and Tests

• Lepromin skin test can be used to distinguish lepromatous from tuberculoid
leprosy, but is not used for diagnosis
• Skin lesion biopsy
• Skin scraping examination for acid fast bacteria

Treatment
A number of different antibiotics are used to kill the bacteria that cause the disease.

Aspirin, prednisone, or thalidomide are used to control inflammation.

Outlook (Prognosis)
Early recognition is important. Early treatment limits damage by the disease, renders
the person noninfectious (you can't catch the disease from them), and allows for a
normal lifestyle.
Possible Complications
• Cosmetic disfigurement
• Permanent nerve damage

When to Contact a Medical Professional

Call your health care provider if you have symptoms of leprosy, especially if you've had
contact with someone who has the disease. Cases of leprosy in the United States need
to be reported to the Centers for Disease Control and Prevention.

Prevention
Prevention consists of avoiding close physical contact with untreated people. People on
long-term medication become noninfectious (they do not transmit the organism that
causes the disease).

Alternative Names
Hansen's disease

Lepros
y

Leprosy (Hansen's disease) is a chronic infection caused by the

bacteria Mycobacterium leprae. It results in damage primarily to the
peripheral nerves (the nerves outside the brain and spinal cord), skin,
testes, eyes, and mucous membrane of the nose.

• Leprosy ranges from mild (with one or a few skin areas affected) to
 severe (with many skin areas affected and damage to many
organs).
• Rashes and bumps appear, the affected areas become numb, and
muscles may become weak.

• The diagnosis is suggested by symptoms and confirmed by a

biopsy of the affected tissue.
• Antibiotics can stop leprosy from progressing but cannot reverse
any nerve damage or deformity.

Because without treatment, people with leprosy are visibly disfigured and
often have significant disability, they have long been feared and shunned
by others. Although leprosy is not highly contagious, rarely causes death,
and can be effectively treated with antibiotics, it still causes anxiety. As a
result, people with leprosy and their family members often suffer
psychologic and social problems.

During 2007, over 250,000 new cases were reported. About 90% of these
cases occurred in the following eight countries (from the most cases to
the least): India, Brazil, Indonesia, Congo, Bangladesh, Nigeria, Nepal,
and Ethiopia. In 2006, 137 new cases were reported in the United States.
Cases occurred in 30 states, but over half occurred in six states:
California, Florida, Louisiana, Massachusetts, New York, and Texas.
Almost all cases of leprosy in the United States involve people who
emigrated from developing countries.

Leprosy can develop at any age but appears to develop most often in
people aged 5 to 15 years or over 30.

How leprosy is spread is unclear. However, it may be passed from

person to person through droplets expelled from the nose and mouth of
an infected person and breathed in or touched by an uninfected person.
But even after contact with the bacteria, most people do not contract
leprosy. About half of the people with leprosy probably contracted it
through close, long-term contact with an infected person. Casual and
short-term contact does not seem to spread the disease. Leprosy cannot
be contracted by simply touching someone with the disease, as is
commonly believed. Health care workers often work for many years with
people who have leprosy without contracting the disease. Armadillos are
the only confirmed source other than people, although other animal and
environmental sources may exist.

About 95% of people who are infected with Mycobacterium leprae do not
develop leprosy because their immune system fights off the infection.
People who develop leprosy may have genes that make them susceptible
to the infection once they are exposed.

Classification: Leprosy can be categorized by the type and number of

skin areas affected. Those with 5 or fewer affected skin areas have
leprosy that is called paucibacillary. People should have no bacteria
detectable on samples from those areas. Those with 6 or more affected
areas have leprosy that is called multibacillary. People may or may not
have bacteria detected on samples from those areas.

Leprosy can also be classified as tuberculoid, lepromatous, or borderline

according to the symptoms people have and other findings. People with
tuberculoid leprosy typically have few skin areas affected (paucibacillary),
and the disease is milder, less common, and less contagious. People
with lepromatous and borderline typically have more skin areas affected
(multibacillary), and the disease is more severe, common, and
contagious.

In both classifications, the type of leprosy dictates the long-term

prognosis, likely complications, and how long antibiotic treatment is
needed.

Tuberculoid
Leprosy

Symptoms
Because the bacteria that cause leprosy multiply very slowly, symptoms
usually do not begin until at least 1 year after people have been infected.
On average, symptoms appear 5 to 7 years after infection. Once
symptoms begin, they progress slowly.
Leprosy affects mainly the skin and peripheral nerves Characteristic
rashes and bumps develop. Infection of the nerves makes the skin numb
or the muscles weak in areas controlled by the infected nerves.

• Tuberculoid leprosy: A rash appears, consisting of one or a few

flat, whitish areas. Areas affected by this rash are numb because
the bacteria damage the underlying nerves.
• Lepromatous leprosy: Many small bumps or larger raised rashes
of variable size and shape appear on the skin. There are more
areas of numbness than in tuberculoid leprosy, and certain muscle
groups may be weak. Much of the skin and many areas of the
body, including the kidneys, nose, and testes, may be affected.

• Borderline leprosy: Features of both tuberculoid and

lepromatous leprosy are present. Without treatment, borderline
leprosy may become less severe and more like the tuberculoid
form, or it may worsen and become more like the lepromatous
form.

The most severe symptoms result from infection of the peripheral nerves,
which causes deterioration of the sense of touch and a corresponding
inability to feel pain and temperature. People with peripheral nerve
damage may unknowingly burn, cut, or otherwise harm themselves.
Repeated damage may eventually lead to loss of fingers and toes. Also,
damage to peripheral nerves may cause muscle weakness that can result
in deformities. For example, the fingers may be weakened, causing them
to curve inward (like a claw). Muscles may become too weak to flex the
foot—a condition called footdrop. Infected nerves may enlarge so that
during a physical examination, doctors can feel them.

Skin infection can lead to areas of swelling and lumps, which can be
particularly disfiguring on the face.

Other areas of the body may be affected:

• Feet: Sores may also develop on the soles of the feet, making
walking painful.

• Nose: Damage to the nasal passages can result in a chronically

stuffy nose and nosebleeds and, if untreated, complete erosion of
the nose.
• Eyes: Damage to the eyes may lead to glaucoma or blindness.
 • Sexual function: Men with lepromatous leprosy may have erectile
dysfunction (impotence) and become infertile. The infection can
reduce the amount of testosterone

and sperm produced by the testes.

• Kidneys: The kidneys may malfunction. In severe cases, kidney
failure may occur.

During the course of untreated or even treated leprosy, the immune

system may produce inflammatory reactions. These reactions can cause
fever and inflammation of the skin, peripheral nerves, and, less
commonly, the lymph nodes, joints, testes, kidneys, liver, and eyes. The
skin around bumps may swell and become red and painful, and the
bumps may form open sores. People may have a fever and swollen
lymph glands.

Diagnosis
Symptoms (such as distinctive rashes that do not disappear, enlarged
nerves, loss of the sense of touch, and deformities that result from
muscle weakness) provide strong clues to the diagnosis of leprosy.

Examination of a sample of infected skin tissue under a microscope

(biopsy) confirms the diagnosis. Because leprosy bacteria do not grow in
the laboratory, culture of tissue samples is not useful. Blood tests to
measure antibodies to the bacteria have limited usefulness because
antibodies are not always present.

Did You Know...

• Leprosy is not easily

spread.

• If leprosy is severe,
people may have to
take antibiotics for the
rest of their life.
Prevention
Because leprosy is not very contagious, risk of spread is low. Only the
untreated lepromatous form is contagious, although even then the
infection is not easily spread. Once treatment has begun, leprosy cannot
be spread. Avoiding contact with bodily fluids from and the rash on
infected people is the best prevention. The BCG (bacille Calmette-
Guérin) vaccine, used to prevent tuberculosis, provides some protection
against leprosy, but it is not often used to prevent leprosy.

Treatment
Antibiotics can stop the progression of leprosy but do not reverse any
nerve damage or deformity. Thus, early detection and treatment are
vitally important. Because some leprosy bacteria are resistant to certain
antibiotics, doctors prescribe more than one drug. The drugs chosen
depend on the type of leprosy:

• Multibacillary: The standard combination of drugs is dapsone

, rifampin

, andclofazimine

. People take rifampin

and clofazimine

once a month under a health care practitioner's supervision. They

take dapsone

plus clofazimine

once a day on their own. This regimen is continued for 12 to 24

months, depending on the severity of the disease.
• Paucibacillary: People take rifampin

once a month with supervision and dapsone

once a day without supervision for 6 months. People who have

only a single affected skin area are given a single dose of rifampin

, ofloxacin

, and minocycline
 .

Dapsone

is relatively inexpensive and generally safe to use. It occasionally causes

allergic rashes and anemia. Rifampin

, which is more expensive, is even more effective than dapsone

. Its most serious side effects are damage to the liver and flu-like
symptoms. Clofazimine

is extremely safe. The main side effect is temporary skin pigmentation.

Because the bacteria are difficult to eradicate, antibiotics must be

continued for a long time. Depending on the severity of the infection and
the doctor's judgment, treatment continues from 6 months to many years.
Some doctors recommend lifelong treatment withdapsone

for people with lepromatous leprosy

Mortality/Morbidity

If severe and left untreated, leprosy can cause clinically significant and debilitating
deformity. Since 1943, when sulfone was introduced as the first effective treatment for
leprosy, antibiotic treatment has dramatically improved patients' outcomes. Early
diagnosis and effective antimicrobial treatment can arrest and even cure leprosy.

Race
Leprosy occurs in persons of all races. African blacks have a high incidence of the
tuberculoid form of leprosy. People with light skin and Chinese individuals tend to
contract the lepromatous type of leprosy. Leprosy is endemic in Asia, Africa, the Pacific
basin, and Latin America (excluding Chile). Leprosy is more a rural than urban disease.

Sex

In adults, the lepromatous type of leprosy is more common in men than in women after
puberty, with a male-to-female ratio of 2:1. In children, the tuberculoid form of leprosy
predominates and no sex preference is reported. Women tend to have a delayed
presentation, which increases rates of deformity.

Age

Leprosy has a bimodal age distribution, with peaks at ages 10-14 years and 35-44
years. Leprosy is rare in infants. Children appear to be most susceptible to leprosy and
tend to have the tuberculoid form.

Leprosy (Hansen's disease)

Last Reviewed: November 2006

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1pg.)
• Versión en español
What is leprosy?

Leprosy is a chronic bacterial disease of the skin and nerves in the hands
and feet and, in some cases, the lining of the nose. Leprosy is a rare disease
in the United States.

Who gets leprosy?

Anyone can get leprosy, but children seem to be more susceptible than
adults.

How is leprosy spread?

It is not clear how the leprosy germ is spread, but household and prolonged
close contact is important. The germs probably enter the body through the
nose and possibly through broken skin. The germs get in the air through
nasal discharge of untreated lepromatous patients.

What are the symptoms of leprosy?

Tuberculoid leprosy symptoms are a few well-defined skin lesions that are
numb. Lepromatous leprosy symptoms are a chronically stuffy nose and
many skin lesions and nodules on both sides of the body.

How soon after exposure do symptoms appear?

It usually takes about four years for tuberculoid leprosy symptoms to appear
and about eight years for lepromatous leprosy symptoms to appear.

When and for how long is a person able to spread leprosy?

In most cases, a person will not infect others after about three months of
starting treatment.

What is the treatment for leprosy?

Patients with leprosy should be treated by a doctor who has experience with
the disease. Treatment is with multiple drugs for six months to two years.

How can leprosy be prevented?

The best way to prevent the spread of leprosy is the early diagnosis and
treatment of people who are infected. For household contacts, immediate
and annual examinations are recommended for at least five years after last
contact with a person who is infectious.