Page 78 - LECTURE NOTES

- Examine the hands and feet for signs of loss of sweating loss of sensation of

palm and sole, ulcer and weakness of muscles
When to diagnose Leprosy?

• Hypopigmented macular lesion with loss of sensation.

• Enlarged, tender peripheral nerve with loss of sensation.
• Puncture skin smear for M/leprae

How to diagnosis leprosy
Leprosy lesion can be patch or nodules

Diagnosis is based on the cardinal signs of leprosy. At least one of the following
cardinal sign must be presnt

1. Anesthetic patch (hypo pigmented patch with loss of sensation)
2. Nerve enlargement and/or tenderness

3. AFB in slit skin smears examination (positive acid fast bacilli in slit skin

smear examination)
If in doubt give an appointment for 3-6 months

The two types of leprosy reaction

1. Type I or reversal reaction

2. Type II or erythema nodosum Leprosum (ENL)

Who is likely to get a type I of reaction (reversal reaction)?
Type1 reaction is caused by increased activity of the body is immune system in fighting

the leprosy bacilli. It occur in people who have strong all mediated immunity
Both paucibacillary and multibacillary get type 1 reaction and commonly seen within six

months of starting treatment, but some of patients may show this reaction before
starting treatment even before leprosy has been diagnosed.

What are the clinical features of type I reaction?
The most common clinical feature is inflammation in the skin patches with swelling,

redness and warmth. The patches are not usually painful, but there may be some
discomfort associated with swelling of the limbs or face may occur. The peripheral

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