Presentation on leprosy

1. Case
A 28 years male presented
with this lesion in his arm
for 2 months.
What do you see??
What do you ask??
What do you examine??
Differential diagnosis??
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2. Leprosy
By:
Dr. Pawan KB Agrawal, MD
Consultant General Practitioner ,
Bayalpata Hospital, Accham.
8th November, 2016, Tuesday.
Dermatology Series

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4. Prevalence
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5. Introduction
• a chronic infection caused by the acid-fast,
rod-shaped bacillus Mycobacterium
leprae.
• primarily affect superficial tissues,
especially the skin and peripheral nerves.
• highly stigmatized; visible debilities and
sequelae
• probably spread by the respiratory route
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7. Presentation
• Symptoms:
– patch with loss of sensation but not itchy
(Loss of sensation in tuberculoid leprosy,
unlike lepromatous leprosy, in which it is
preserved.)
– Loss of sensation or paresthesias over
distribution of affected peripheral nerves.
– Wasting and muscle weakness
– Foot drop or clawed hands
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9. Presentation
– Foot ulcers
– Iridocyclitis, corneal ulcers
• Signs:
– Thickened nerves
• Ulnar ; Superficial radial cutaneous; Median ; Common
peroneal ; Great auricular .
– perineum, scalp, and axilla: not normally
involved
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10. PB vs MB
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11. Ridley Jopling Classification
• TL: sharply demarcated hypopigmented macule with
assymetric nerve involvement.
• BT: few or moderate and asymmetric; peripheral
nerves often involved
• BB: Moderate lesions; symmetric nerve
involvement.
• BL: Numerous lesions; symmetric nerve
involvement.
• LL: symmetric involvement with numerous macules,
nodules, plaques, or papules; poorly defined borders
and raised and indurated centers.
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13. Differentials
• T. versicolor
• T. corporis
• P. rosea
• Vitiligo
• Diabetic neuropathy
• Sarcoidosis
• Secondary syphilis
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14. Diagnosis
• WHO:
–one or more of the following:
• Hypopigmented or reddish skin
lesions with loss of sensation
• Involvement of the peripheral nerves
as demonstrated by their thickening
and associated loss of sensation
• Skin smear positive for acid-fast bacilli
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16. Investigations
• Slit skin smear
• Skin biopsy
• CBC
• RFT
• LFT
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17. Treatment
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18. Treatment
• Mainly 3 drugs:
– Dapsone, rifampin & clofazimine.
• Steroids may be helpful in severe pain with nerve
involvement.
• ROM regimen for single PB lesion.
• Surgeries: reconstruction; cosmesis.
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19. Treatment
• Response: The erythema and induration of
skin lesions diminish within a few months but
may take few years.
• Follow up: first follow up in 2-4 weeks to
evaluate side effects of medications thereafter
routine follow-up every three months.
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20. THANK YOU>>
So, do you get your take home
message??