World Leprosy Week is in February! Although the number of new leprosy cases per year is decreasing, it is a condition still being diagnosed today. This condition is thought to have originated in India where reports of leprosy date back as early as 2000 BC. Today, it is primarily seen in tropical and subtropical regions across the globe, with the highest incidence in Brazil. But did you know, although not frequent, new diagnoses of leprosy are continuing to be reported in our state of Louisiana?
What is this condition, leprosy? Leprosy is nothing more than an infection by a slow-growing species of bacteria called Mycobacterium leprae. Since these microorganisms can only grow at cooler temperatures, it primarily infects the skin and nerves found on cooler areas of the body, such as the face, earlobes and extremities. It is still unclear exactly how the disease is transmitted, but it is thought to be through nasal and oral droplets from a contagious person. Although leprosy is a contagious infection, it is not easy for a person to “catch it”. It requires close contact with an infectious person, but even then, the risk of acquiring the disease is still only 25%. Once diagnosed, patients with leprosy can be cured with extended courses of antibiotics.
Why the stigma associated with this disease? When leprosy first became an entity, it evoked fear in people because little was known about the disease and because of the propensity for leprosy to cause deformities and disability. Because of this uncertainty, people with leprosy were ostracized from their communities. In fact, in the 1800s, a group of patients with leprosy were banished to an abandoned sugar plantation along the Mississippi River in Carville, Louisiana, now known as the National Hansen’s Disease Museum. Since there was no known treatment at that time, many lived out their lives there. Today, leprosy continues to be stigmatized largely because it is misunderstood, so it has been given an alternate name, Hansen’s disease, after the physician who first identified M. leprae as the cause of leprosy.
Hansen’s disease may have a variety of clinical presentations. It could look like a single, red to apple jelly-colored, circular spot with central clearing on the skin, or more involved with thickened plaques that are too numerous to count and enlarged nerves in areas that are infected. Because the microorganisms infect nerves, there may be a loss of sensation in the skin lesions. The nerve damage may subsequently lead to ulcers and deformities.
In my five years of practicing dermatology in Louisiana, I have diagnosed and am currently treating a small number of patients with Hansen’s disease. After receiving the first biopsy report that was consistent with leprosy, I heard remarks like, “I didn’t know leprosy was still a thing?” from many of my staff. That is what prompted me to write this article. I believe it is my job as a dermatologist to educate my patients, my staff and others about this misunderstood disease in the hopes that we can remove the stigma that has long been associated with this now curable condition.
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