1. 1 Diagnosis of leprosy - Part II. The 1 st cardinal signs of leprosy 1 Salvatore Noto, Pieter A M Schreuder and Bernard Naafs Leprosy mailing list, October 2011 LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

2. 2 “Skin patch with loss of sensation” 2 The 1 st cardinal sign of leprosy LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

3. 3 Testing for loss of sensation Courtesy of B. Naafs LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

4. 44 Testing for loss of sensation 1. Explain 2. Demonstrate 3. Test when the patient comprehends fully Courtesy of: S Noto LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

5. 5 Courtesy of: S Noto Hypopigmentation Distribution Margins Streaming and satellite lesions Leprosy Loss of sensation? Yes LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

6. 66 Distribution Margins Streaming and satellite lesions Surface is dry Loss of sensation? Yes. Leprosy Courtesy of: S Noto LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

7. 77 The sweat and histamine tests Addendum LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

8. 8 Loss of sweating in hypopigmented leprosy macules Courtesy of Grace Warren Borderline leprosy The big leprosy lesion (arrow) is definitely dry while the normal skin is shiny from the reflection from the moisture of the sweat. LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

9. 9 Loss of sweating in hypopigmented leprosy macula Courtesy of Khon Kaen leprosarium On the right side of the slide a round dry hypopigmented leprosy lesion. On the left normally pigmented skin with drops of sweat LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign

10. 10 Diminished response (reduced redness) to injection of histamine = leprosy lesion Courtesy of J A da Costa Nery Normal response (redness) to injection of histamine = normal skin The histamine test LML October 2011 - The diagnosis of leprosy - Part II. 1st cardinal sign