08.08.07
Leprosy Treatment
Previously it was believed that the leprosy patients discharged the leprosy bacilli from their skin, which get lodged onto the skin of other individuals living in close contact with the patient. Thus, skin to skin contact was considered to be the most important mode of transmission of the leprosy bacilli. Now however, it is known that the leprosy bacilli do not invade the superficial layer (epidermis) of the skin and therefore, the leprosy bacilli are not discharged through the skinunless the patient has a skin ulcer or other types ofbreaks in the skin.
On the other hand, large numbers of bacilli are present in the nasal (nose) or the oral (mouth) secretions. Thus,when a patient speaks, coughs, or sneezes, he is likely to throw out a large number of these bacilli which spread into the environment and cause infection in the other individuals. Only those patients are capable ofinfecting.the other individuals who have widespread infection which also involves the respiratory passages (nose and other areas) or the oral cavity (mouth) or have skin ulcers. This type of leprosy occurs in only a few of the leprosy patients, which means that there is almost no risk of getting infection from a fairly large proportion of the leprosy patients.
The manifestations of leprosy vary widely in different individuals. In a mild form of the disease, there may be only a single or at the most a few patches which may either be lighter in colour or red and raised. The most important component of this type of lesion is that the perception of touch, pain, heat and cold in these areas is either completely lost or impaired. The dermatologist may also be able to detect that the nerve in this region is also involved.
When the immunity is low, the patient can have a larger number of patches located on any part of the body. In the severe forms, such patches may involve almost all the areas of the skin; and there may be several nodules and even the entire skin may become thickened and corrugated, giving a very characteristic appearance to the patient. The bacilli in these patients spread to almost the entire body including the internal organs, especially the nerves, the lymph nodes, the liver, and the lungs. The only organs in the body which are known not to be infected by the leprosy bacilli are the brain, the spinal cord and the ovaries.
In severe forms of leprosy, the sensory loss is relatively less but the diagnosis can be confirmed by demonstrating the bacilli in the lesions, by preparing smears from small amounts of the material taken from the skin and staining with special stains. This method is called the ’slit-and-smear examination’.
There are several other manifestations of leprosy which depend upon the involvement of different regions of the body, such as loss of hair in the outer half of the eyebrows, stuffiness of the nose (blockage), bleeding from the nose (epistaxis), enlargement of the breasts in the male (gynaecomastia), absorption of the terminal portions of the fingers (shortening of the fingers and toes) and deep painless ulcers (trophic ulcers). It must however, be remembered that each of these manifestations are far more commonly seen as a manifestation of a variety of other diseases and thus the presence of an isolated sign or symptom does not mean that the patient has developed leprosy. It would be necessary to have the evaluation done by an experienced dermatologist for proper diagnosis.
Thus, if a person has loss of the temperature sensation on the hand or forearms, the person has to avoid touching or holding hot objects, and if a person has loss of pain sensation on any area of the body, especially the feet, the person must inspect those areas every day and take prompt appro- priate action if there is any indication of damage to the skin. Patients with sensory loss on the feet must avoid ill-fitting shoes and prefer to wear only soft and smooth footwear.