Leprosy

Abstract Leprosy is a chronic granulomatous disease caused by infection of the skin and nerves with Mycobacterium leprae and M. lepromatosis and about 220 000 new cases are diagnosed annually, 60% in India. The patient’s host immune response to the mycobacterium determines clinical presentation and the occurrence of immune‐mediated reactions and neuritis. Skin lesions range from anaesthetic macules to nodules. Diagnosis is clinically based on the type of skin lesions, peripheral nerve thickening and presence of mycobacteria in the skin. A skin biopsy is often useful in diagnosing leprosy. Nerve damage causes sensorimotor damage affecting the hands, feet and eyes. The infection is readily treatable with a combination of antibiotics (rifampicin, dapsone, clofazimine) but the associated nerve damage and inflammation is difficult to switch off and patients may need repeated courses of steroid treatment. Leprosy patients are still stigmatised and this needs combatting at all levels; most patients are not infectious.