World Hansen’s Disease Awareness Day

What is Hansen’s disease?

Hansen’s disease (also known as leprosy) is an infection caused by bacteria called Mycobacterium leprae. These bacteria grow very slowly and it may take up to 20 years to develop signs of the infection.

The disease can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). The bacteria attack the nerves, which can become swollen under the skin. This can cause the affected areas to lose the ability to sense touch and pain, which can lead to injuries, like cuts and burns. Usually, the affected skin changes color and either becomes:

  • lighter or darker, often dry or flaky, with loss of feeling, or
  • Reddish due to inflammation of the skin

If left untreated, the nerve damage can result in paralysis of hands and feet. In very advanced cases, the person may have multiple injuries due to lack of sensation, and eventually the body may reabsorb the affected digits over time, resulting in the apparent loss of toes and fingers. Corneal ulcers and blindness can also occur if facial nerves are affected. Other signs of advanced Hansen’s disease may include loss of eyebrows and saddle-nose deformity  resulting from damage to the nasal septum.

Early diagnosis and treatment usually prevent disability that can result from the disease, and people with Hansen’s disease can continue to work and lead an active life. Once treatment is started, the person is no longer contagious. However, it is very important to finish the entire course of treatment as directed by the doctor.

Each year, about 150 people in the United States and 250,000 around the world External get the illness. In the past, Hansen’s disease was feared as a highly contagious, devastating disease, but now we know that it’s hard to spread and it’s easily treatable once recognized. Still, a lot of stigma and prejudice remains about the disease, and those suffering from it are isolated and discriminated against in many places where the disease is seen. Continued commitment to fighting the stigma through education and improving access to treatment will lead to a world free of this completely treatable disease.

Transmission

How do people get Hansen’s disease?

It is not known exactly how Hansen’s disease spreads between people. Scientists currently think it may happen when a person with Hansen’s disease coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria. Prolonged, close contact with someone with untreated leprosy over many months is needed to catch the disease.

You cannot get leprosy from a casual contact with a person who has Hansen’s disease like:

  • Shaking hands or hugging
  • Sitting next to each other on the bus
  • Sitting together at a meal

Hansen’s disease is also not passed on from a mother to her unborn baby during pregnancy and it is also not spread through sexual contact.

Due to the slow-growing nature of the bacteria and the long time it takes to develop signs of the disease, it is often very difficult to find the source of infection.

Signs and Symptoms

Symptoms mainly affect the skin, nerves, and mucous membranes (the soft, moist areas just inside the body’s openings).

The disease can cause skin symptoms such as:

A large, discolored lesion on the chest of a person with Hansen’s disease.

  • Discolored patches of skin, usually flat, that may be numb and look faded (lighter than the skin around)
  • Growths (nodules) on the skin
  • Thick, stiff or dry skin
  • Painless ulcers on the soles of feet
  • Painless swelling or lumps on the face or earlobes
  • Loss of eyebrows or eyelashes

Symptoms caused by damage to the nerves are:

  • Numbness of affected areas of the skin
  • Muscle weakness or paralysis (especially in the hands and feet)
  • Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
  • Eye problems that may lead to blindness (when facial nerves are affected)

Enlarged nerves below the skin and dark reddish skin patch overlying the nerves affected by the bacteria on the chest of a patient with Hansen’s disease. This skin patch was numb when touched.

Symptoms caused by the disease in the mucous membranes are:

  • A stuffy nose
  • Nosebleeds

Since Hansen’s disease affects the nerves, loss of feeling or sensation can occur. When loss of sensation occurs, injuries such as burns may go unnoticed. Because you may not feel the pain that can warn you of harm to your body, take extra caution to ensure the affected parts of your body are not injured.

If left untreated, the signs of advanced leprosy can include:

  • Paralysis and crippling of hands and feet
  • Shortening of toes and fingers due to reabsorption
  • Chronic non-healing ulcers on the bottoms of the feet
  • Blindness
  • Loss of eyebrows
  • Nose disfigurement

Other complications that may sometimes occur are:

  • Painful or tender nerves
  • Redness and pain around the affected area
  • Burning sensation in the skin

Diagnosis and Treatment

How is the disease diagnosed?

Hansen’s disease can be recognized by appearance of patches of skin that may look lighter or darker than the normal skin. Sometimes the affected skin areas may be reddish. Loss of feeling in these skin patches is common. You may not feel a light touch or a prick with a needle.

To confirm the diagnosis, your doctor will take a sample of your skin or nerve (through a skin or nerve biopsy) to look for the bacteria under the microscope and may also do tests to rule out other skin diseases.

How is the disease treated?

Hansen’s disease is treated with a combination of antibiotics. Typically, 2 or 3 antibiotics are used at the same time. These are dapsone with rifampicin, and clofazimine is added for some types of the disease. This is called multidrug therapy. This strategy helps prevent the development of antibiotic resistance by the bacteria, which may otherwise occur due to length of the treatment.

Treatment usually lasts between one to two years. The illness can be cured if treatment is completed as prescribed.

If you are treated for Hansen’s disease, it’s important to:

  • Tell your doctor if you experience numbness or a loss of feeling in certain parts of the body or in patches on the skin. This may be caused by nerve damage from the infection. If you have numbness and loss of feeling, take extra care to prevent injuries that may occur, like burns and cuts.
  • Take the antibiotics until your doctor says your treatment is complete. If you stop earlier, the bacteria may start growing again and you may get sick again.
  • Tell your doctor if the affected skin patches become red and painful, nerves become painful or swollen, or you develop a fever as these may be complications of Hansen’s disease that may require more intensive treatment with medicines that can reduce inflammation.

If left untreated, the nerve damage can result in paralysis and crippling of hands and feet. In very advanced cases, the person may have multiple injuries due to lack of sensation, and eventually the body may reabsorb the affected digits over time, resulting in the apparent loss of toes and fingers. Corneal ulcers or blindness can also occur if facial nerves are affected, due to loss of sensation of the cornea (outside) of the eye. Other signs of advanced leprosy may include loss of eyebrows and saddle-nose deformity resulting from damage to the nasal septum.

Antibiotics used during the treatment will kill the bacteria that cause leprosy. But while the treatment can cure the disease and prevent it from getting worse, it does not reverse nerve damage or physical disfiguration that may have occurred before the diagnosis. Thus, it is very important that the disease be diagnosed as early as possible, before any permanent nerve damage occurs.

Treatment:

Hansen’s disease is treated with multidrug therapy (MDT) using a combination of antibiotics depending on the form of the disease:

  • Paucibacillary form – 2 antibiotics are used at the same time, daily dapsone and rifampicin once per month
  • Multibacillary form – daily clofazimine is added to rifampicin and damson.

Treatment usually lasts between one to two years. The illness can be cured if treatment is completed as prescribed.

Open chat