About Leprosy
FAQ's - The Basics
What is leprosy?
Leprosy is caused by bacteria or germs called Mycobacterium leprae. It is an infection affecting the skin and the nerves of the hands and feet, and can also cause problems in the eyes and nose.
Why is leprosy also called Hansen's disease?
The medical name for leprosy is, Hansen's Disease. Dr. Armauer Hansen of Norway was the first to see the leprosy germ under a microscope. This was 1873, and Hansen's discovery was revolutionary. The evidence was clear: a germ (Mycobacterium leprae) causes leprosy. It was not hereditary, a curse, or from sin.
Is leprosy in the Bible the same as it is today?
Not necessarily. The Hebrew word for leprosy refers to many types of skin diseases.
How is it spread?
In most cases, it is spread through long-term contact with a person who has the disease but has not been treated.
Most people will never develop the disease even if they are exposed to the bacteria. Of the world's population, 95% have a natural immunity to leprosy.
In South Louisiana and Texas, some armadillos carry the bacteria. We do not know for certain if humans can get the bacteria from armadillos.
Is leprosy a genetic disease?
Leprosy is not a genetic disease. Most people with leprosy do not have other family members affected, although occasionally several members of one family are affected. Healthy people with a robust immune system, decent nutrition and living in relatively hygienic surroundings are even less likely to contract leprosy.
Can other people get leprosy from a patient?
Patients on medication for leprosy do not spread the disease. When a person is placed on medication, most of the bacteria are killed within a few days. Within two weeks of starting the medicine, there is no risk of spreading the disease to anyone else.
It is not necessary to isolate a person with leprosy at any time. Also, it is NOT transmitted through sexual contact or pregnancy.
Do household members need treatment?
It is not necessary for them to take any medication. When someone is diagnosed with leprosy, a physician should examine all the household members for any sign of the disease. The physician determines any need for further follow-up exams at that time.
What are the earliest signs of leprosy?
The most common first sign is usually a patch or spot on the skin that may be slightly red, darker, or lighter than normal skin. The spot may also become numb and have lost hair.
Some of these patches may slowly increase in size and new patches may appear on other parts of the body. More often they appear on the arms, legs, or back. Sometimes the only sign may be numbness in a finger or toe.
What about stories of fingers and toes dropping off?
Repeated injury and infection of numb areas in fingers and/or toes causes bone to become shorter. The tissues around the area shrinks, making the digit much shorter. This is probably how those stories got started. Also, badly damaged, ulcerous and gangrenous extremities may need to be amputated.
What tests can be done to make the diagnosis?
A physician diagnoses leprosy through a skin biopsy. In this test, a small piece of skin is taken from the affected skin and sent to laboratory where it is examined for the bacteria.
Skin smears are another test that can be used to make the diagnosis. This is done by making a small incision into the skin. A small amount of tissue fluid is obtained and examined in the laboratory for the bacteria. There are no blood tests for leprosy.
How is it treated?
All newly diagnosed persons take three medications: dapsone, rifampin, and clofazimine. They may be taken for six months or longer.
Most people with leprosy take their medication at home. They continue their regular jobs and daily activities.
The medications now available are very effective in killing the bacteria. The disease can be completely cured if the medications are taken as prescribed.
What side effects do the medications have?
Dapsone: Some people may have mild anemia. Very rarely, other blood problems have been reported.
Rifampin: Sometimes rifampin will cause abnormal liver tests, but the problem clears when the medication is stopped. It may cause a harmless orange color in the urine, sweat, or tears.
Clofazimine: Clofazimine has virtually no side effects except some darkening of the skin. This effect slowly fades when the medication is stopped.
What is a leprosy reaction?
Reaction is the body's response to the dead bacteria in the body. When patients begin taking medications, the bacteria are killed quite rapidly. The dead bacteria remain in the body for a period of time. Sometimes it takes a number of years for the dead bacteria to be completely cleared from the body.
During this time the body may react against these dead bacteria causing pain and swelling in the skin, nerves and other parts of the body. This is what is known as a reaction. Approximately 50% of people with leprosy have reactions sometime during the course of their treatment.
A reaction does not mean the disease is getting worse, or that the medication has stopped working. It is not an allergic reaction to the medication. It means that the body’s immune system is reacting or fighting against the dead bacteria.
These bacteria may have been killed by the body's resistance to the bacteria or by the medication. This is why some people develop reactions before they even start on medication.
Reactions cause redness, swelling or painful nodules on the skin areas already present affected. There may be pain and swelling in the hands and feet, and painful nerves in the arms and legs. Fever and muscle aches may also occur. The eyes could be red and painful in some cases.
During reactions there is increased risk of damage to nerves in the eyes, hands and fee. Treating reaction quickly can prevent nerve damage.
Why is medication continued if reaction occurs?
If medications which kill bacteria were not given, the bacteria would begin growing again. The disease would get worse.
How are reactions treated?
Some reactions can be treated with aspirin or Tylenol. In some cases, medication such as prednisone or similar drugs may be required to prevent nerve damage during reaction.
Episodes of reaction may occur off and on for a period of time. If patients need to take prednisone for a long period of time, there are side effects that need to be explained by their doctor. Prednisone should not be stopped suddenly.
The risks of nerve damage and permanent disabilities in hands, feet or eyes are also serious and must be considered against the risk of side-effects. If prednisone is given at the lowest effective dose and for the shortest time possible, the risk of serious side effects is quite low.
Thalidomide is another medication used to treat some types of reactions. It is very effective and can be used instead of prednisone in some persons. It has fewer side effects than prednisone.
However, Thalidomide can cause severe birth defects if given to pregnant women. It is not given to women of childbearing age except in extreme cases and only after rigorous precautions have been taken.
What happens to pregnant women who have leprosy?
Most women with leprosy have normal pregnancies and deliver healthy babies.
Generally, dapsone and clofazimine can be taken during the pregnancy, but rifampin is usually stopped until after the baby is born. Patients on treatment do not transmit leprosy to their babies.
PREVENTING DISABILITY
What happens to the eye in leprosy?
Leprosy can affect the eyes in several ways. The ability to feel something in the eye may be lost, making it easier for damage to occur. It can also cause dry eyes by decreasing tear production. Tears protect the eye by keeping it moist and healthy.
Bacteria can invade the cooler part of the eye. Reactions may also involve the eye and may cause a painful ‘red eye’. If this occurs the patient must be attended to by an eye doctor immediately to prevent loss of vision.
What type of nerve damage occurs?
Leprosy can damage the peripheral nerves in the skin. This damage can lead to:
- Loss of sweat and oil gland function which causes dry, cracked skin on hands and feet.
- Loss of the ability to feel light touch or, with more severe damage, loss of protective sensation. Protective pain sensation prevents burns, cuts, exposure to harmful elements, and exposure to destructive pressures on the hands and feet.
- Weakness of the eyelids, preventing proper closure of the lid which protects the eye.
- Loss of strength in the hands and feet. With severe nerve damage of the hands and feet, there is paralysis of the small muscles, leading to ‘clawing’ of the fingers and toes.
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Taking care of skin
- Carefully (and slowly) sand off any dead, thickened skin or calluses. An emery board or fine sandpaper will help remove the dead skin without causing injury. Never use a sharp blade on insensitive skin.
- For dryness, soak hands and feet in warm water once a day for 20 minutes, pat dry, and apply petroleum jelly or oil to all skin areas except between the toes. Do not use soaps or bubble baths while soaking.
- Do not use hot water bottles or heating pads on areas that have lost feeling.
- Use artificial tears twice a day for dryness.
- Check eyes in a mirror daily for redness or for anything that may irritate the eyes.
- Wear sunglasses for protection against the glare of the sun, dust and wind. Wraparound glasses and wide-brimmed hates offer good protection.
- Report pain, redness, or changes in vision to your nurse, doctor, or health worker.
- Inspect hands daily for cuts, blisters or warm, red areas. Protect open wounds from dirt and moisture with bandages. Injuries are a route for infection. If you notice swelling, redness, or increased temperature, consult a doctor immediately.
- Consult a doctor if you experience numbness, weakness or tingling in your hands.
- Wear gloves when cooking, gardening, or working with tools.
- Use long-handled utensils when cooking.
- Inspect feet every day for warm, red areas that are signs of inflammation. You can use a mirror to check the bottom of your feet. Contact your doctor if you have an open wound (ulcer) on the bottom of your foot.
- Cut toenails straight across and file. Do not cut calluses or corns, or use corn removers.
- Wear socks with shoes.
- Do not walk barefoot, even inside a home.
- Check your shoes for torn lining, rough spots, or objects inside shoes that can injure feet.
Always have your feet measured when buying shoes. There should a half-inch space between the toes and end of shoes. You should also be able to pinch a small area on top of the toe at the widest point, to determine if they are wide enough. The toe box should be roomy.
Choose a thick rubber sole for support.
Leather shoes are preferable. An inexpensive, good walking tennis shoe will also help. Avoid pointed toes or high heels.
From Living with Hansen's Disease: Questions and Answers, published by the Gillis W. Long Hansen's Disease Center, National Hansen's Disease Program of the U.S. Department of Health and Human Services, Carville, Louisiana. (Funding provided by American Leprosy Missions.)
