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rosy
Borderline leprosy
F orm s betw een tuberculoid an d lep rom atous.
Indeterminate leprosy (I)
F orm that d oes n ot fall in the R id ley-Jop lin g classification , freq uen t in child ren : a sin gle
w ell-d em arcated m acule, hyp op igm en ted on d ark sk in , slightly erythem atous on p ale
sk in . A bsen ce of sw eat an d hair, an d loss of sen sation are in con stan t.
L esion heals sp on tan eously or the d isease evolves tow ard s tuberculoid or lep rom atous
lep rosy.
Lepra reactions
– Reversal reactions: occur in p atien ts w ith bord erlin e lep rosy, d urin g treatm en t, w hen
evolvin g tow ard s tuberculoid lep rosy. S k in lesion s becom e sw ollen an d p ain ful w ith
a risk of n ecrosis an d ulceration . A cute p ain ful n euritis (uln ar n erve) req uires urgen t
treatm en t (see p age 1 1 5 ) as there is a risk of p erm an en t seq uelae.
– Downgrading reactions: occur in un treated p atien ts w ith bord erlin e lep rosy, w hen the
d isease evolves tow ard s lep rom atous lep rosy. T h ese reaction s are d ifficult to
d istin guish from reversal reaction s.
– Erythema nodosum leprosum: crop s of ten d er subcutan eous n od ules, p urp lish-red , then
yellow ish in colour. T h is reaction is seen exclusively in p atien ts w ith lep rom atous
lep rosy d urin g the first year of treatm en t.
In ord er to sim p lify d iagn osis an d to p rom ote rap id im p lem en tation of treatm en t, the
W H O sim p lified clin ical classification of lep rosy an d d ifferen tiates on ly 3 form s:
– M ultibacillary lep rosy: m ore than 5 sk in lesion s
– P aucibacillary lep rosy: 2 to 5 sk in lesion s
– S in gle sk in lesion p aucibacillary lep rosy
Laboratory
D em on stration of acid -fast bacilli in a Ziehl-N eelsen stain ed sm ear:
– n asal sm ear
– sk in -sp lit sm ear tak en from the ear lobe or from a sk in lesion
In tuberculoid lep rosy, bacilli are usually n ot foun d .
Treatment
Treatment of leprosy
– L ep rosy is a curable d isease. E arly an tibiotic treatm en t p reven ts fun ction al seq uelae
an d tran sm ission of the d isease.
– In coun tries w here lep rosy is en d em ic, it is im p ortan t to be in form ed about n ation al
con trol p rogram m es.
– T he high rates of resistan ce an d of recurren ces after sin gle d rug therap y have led to
the use of effective m ulti-d rug therap y regim en s w hich are easy to ad m in ister in th e
field an d for w hich n o resistan ce has been rep orted .
– T each the p atien t to recogn ise an d q uick ly rep ort a lep ra reaction or relap se in ord er
to m od ify or restart treatm en t.
114
Borderline leprosy
F orm s betw een tuberculoid an d lep rom atous.
Indeterminate leprosy (I)
F orm that d oes n ot fall in the R id ley-Jop lin g classification , freq uen t in child ren : a sin gle
w ell-d em arcated m acule, hyp op igm en ted on d ark sk in , slightly erythem atous on p ale
sk in . A bsen ce of sw eat an d hair, an d loss of sen sation are in con stan t.
L esion heals sp on tan eously or the d isease evolves tow ard s tuberculoid or lep rom atous
lep rosy.
Lepra reactions
– Reversal reactions: occur in p atien ts w ith bord erlin e lep rosy, d urin g treatm en t, w hen
evolvin g tow ard s tuberculoid lep rosy. S k in lesion s becom e sw ollen an d p ain ful w ith
a risk of n ecrosis an d ulceration . A cute p ain ful n euritis (uln ar n erve) req uires urgen t
treatm en t (see p age 1 1 5 ) as there is a risk of p erm an en t seq uelae.
– Downgrading reactions: occur in un treated p atien ts w ith bord erlin e lep rosy, w hen the
d isease evolves tow ard s lep rom atous lep rosy. T h ese reaction s are d ifficult to
d istin guish from reversal reaction s.
– Erythema nodosum leprosum: crop s of ten d er subcutan eous n od ules, p urp lish-red , then
yellow ish in colour. T h is reaction is seen exclusively in p atien ts w ith lep rom atous
lep rosy d urin g the first year of treatm en t.
In ord er to sim p lify d iagn osis an d to p rom ote rap id im p lem en tation of treatm en t, the
W H O sim p lified clin ical classification of lep rosy an d d ifferen tiates on ly 3 form s:
– M ultibacillary lep rosy: m ore than 5 sk in lesion s
– P aucibacillary lep rosy: 2 to 5 sk in lesion s
– S in gle sk in lesion p aucibacillary lep rosy
Laboratory
D em on stration of acid -fast bacilli in a Ziehl-N eelsen stain ed sm ear:
– n asal sm ear
– sk in -sp lit sm ear tak en from the ear lobe or from a sk in lesion
In tuberculoid lep rosy, bacilli are usually n ot foun d .
Treatment
Treatment of leprosy
– L ep rosy is a curable d isease. E arly an tibiotic treatm en t p reven ts fun ction al seq uelae
an d tran sm ission of the d isease.
– In coun tries w here lep rosy is en d em ic, it is im p ortan t to be in form ed about n ation al
con trol p rogram m es.
– T he high rates of resistan ce an d of recurren ces after sin gle d rug therap y have led to
the use of effective m ulti-d rug therap y regim en s w hich are easy to ad m in ister in th e
field an d for w hich n o resistan ce has been rep orted .
– T each the p atien t to recogn ise an d q uick ly rep ort a lep ra reaction or relap se in ord er
to m od ify or restart treatm en t.
114
