1. Ma. Bernadette V. Lopez-Dee Adrian B. Lorenzo
Hansen’s Disease
Ma. Bernadette V. Lopez-Dee
Adrian B. Lorenzo

2. Epidemiology Global prevalence – 1.25 cases per 10,000 persons
India – 80% worldwide
Male to female ratio of occurrence – 1.5 : 1
Age of occurence – before 35 (endemic areas),
age 50 (exposure to armadillos)
Latency period – 5 years (paucibacillary), 20 years (multibacillary)
Mode of transmission – armadillo exposure, other cases of Hansen’s disease
Close contact – 28 % (household contacts)
- 80 % (neighbors, social contacts)

3. Infectious agent Mycobacterium leprae Weakly acid-fast organism
Grows best at 30 ̊C below human body core temperature
Long generation time (12-14 days)
Unable to be cultured in vitro

4. Diagnosis Identification of infectious organism in affected tissue
Skin biopsies: from skin or nerve lesions – stained for bacillus with Fite-Faraco stain
Slit smears: from lesions and cooler areas of skin – stained with Acid-fast stain
organisms found – multibacillary
5 or few lesions/ negative – paucibacillary

5. Classification Early and Indeterminate leprosy Tuberculoid leprosy
Borderline tuberculoid leprosy
Borderline leprosy
Borderline lepromatous leprosy
Lepromatous leprosy
Histoid leprosy

6. 1. Early and Indeterminate Leprosy
Insidious onset
Numbness – first manifestation in 90% of patients
Loss of senses of cold and light touch - earliest sensory changes
Solitary, ill-defined hypopigmented macule- often the first lesion
Erythematous macules (cheeks, upper arms, buttocks, thighs) –less often

7. 1. Early and Indeterminate Leprosy
Biopsy – usually no bacilli or only a few
Few cases remain in this state
Evolve to lepromatous, tuberculoid, or borderline types
Good cell-mediated immunity – often resolve spontaneously or never develop other signs and symptoms of Leprosy

8. 2. Tuberculoid Leprosy Solitary lesions or few in number (5 or less)
Asymmetrical distribution
Lesions – hypopigmented or erythematous, dry, scaly, hairless
Typical lesion – large, erythematous plaque w/ a sharply defined & elevated border that slopes down to a flattened atrophic center – “a saucer right side up”
Common locations – face, limbs, or trunk
Lesion is anesthetic & anhidrotic

9. 2. Tuberculoid Leprosy Nerve involvement – early & prominent
Greater auricular nerve & Superficial peroneal nerve – visibly enlarged
Atrophy of interosseous muscles of hand, w/ wasting of thenar & hypothenar eminences, contracture of fingers, facial muscle paralysis, foot drop
Evolution generally slow
Often, there is spontaneous remission in 3 years, or less if w/ treatment

10. 2. Tuberculoid Leprosy

11. 3. Borderline Tuberculoid Leprosy
Similar to tuberculoid lesions, but smaller and more numerous
Characteristic – satellite lesions around large macules or plaques

12. 3. Borderline Tuberculoid Leprosy

13. 4. Borderline Leprosy Lesions:
Numerous but countable, consist of red, irregularly shaped plaques
Small satellite lesions may surround larger plaques
Generalized but asymmetrical
Edges are not so well defined
Nerves may be thickened and tender
Anesthesia is only moderate

14. 4. Borderline Leprosy

15. 5. Borderline Lepromatous Leprosy
Lesions are symmetrical, numerous (not countable), may include macules, papules, plaques, and nodules
Small lepromatous lesions > larger borderline type lesions
Nerve involvement -appears later, symmetrical
Nerves - enlarged and/or tender
Sensation & sweating over individual lesions are normal
Usually no features of full-blown leprosy (madarosis, keratitis, nasal ulceration, leonine facies)

16. 5. Borderline Lepromatous Leprosy
Hyperpigmentation
due to
Clofazamine

17. 6. Lepromatous Leprosy
Cutaneous lesions – pale lepromatous macules / lepromatous infiltrations w/ numerous bacilli
Becomes progressively worse w/o treatment
Divided into polar form LLp & subpolar form LLs
Macular lepromatous lesions- diffuse & symmetrical distribution, small, numerous, ill-defined, blend into surrounding skin
No loss of sensation over lesions, nerve thickening, nor changes in sweating
Slow, progressive hair loss – outer third of eyebrows, eyelashes, then body. Scalp hair remains unchanged.

18. 6. Lepromatous Leprosy
Lepromatous infiltrations divide into diffuse, plaque, and nodular types
Diffuse type
Diffuse infiltration of face (forehead), madarosis, waxy shiny appearance of skin – “varnished appearance”
Diffuse leprosy of Lucio – 1/3 of lepromatous cases. Diffuse infiltration of skin. Localized lepromas do not form. Unique complication – Lucios’s phenomenon (erythema necroticans)

19. 6. Lepromatous Leprosy
Infiltrations- manifested by development of nodules called lepromas
Early nodules – ill defined, occurs in acral parts (ears, brows, nose, chin, elbows, hands, buttocks, knees)
Nerve involvement – variable, very slow
Nerve disease – bilaterally symmetrical, stocking-glove pattern (misdiagnosed as diabetic neuropathy)

20. 6. Lepromatous Leprosy Multiple papules and nodules
Enlargement of the earlobe

21. 7. Histoid Leprosy Uncommon form of multibacillary leprosy
Skin lesions – yellow-red, shiny, large papules and nodules in dermis or subcutaneous tissue
1- 15 mm in diameter
Appear anywhere, but favor the buttocks, lower back, face, and bony prominences
This pattern may appear de novo, but mostly described in patients w/ resistance to long-acting dapsone resistance

22. 7. Histoid Leprosy