Lepromatous leprosy

dermatology

1. LEPROMATOUS LEPROSYINTRODUCTIONLeprosy (also known Hansen's disease) is an infectious disease caused by Mycobacterium leprae
EPIDEMIOLOGY developing settings; countries with high numbers of cases include India, Brazil, Indonesia, BangladeshPoor housing conditionsOvercrowding play role
MODES OF TRANSMISSIONNot knownprobably spread by the respiratory routeskin to skin contactgastrointestinal route
CLASSIFICATIONRIDLEY JOPPLING CLASSIFICATIONtuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), lepromatous (LL), and Indeterminate
Patients on Tuberculoid end- Good immunity

2. Few bacilliLepromin positiveLarge and few lesions
Patients on lepromatous end Poor immunityMany bacilliLepromin negativeLarge number of lesions Small lesionsSymmetrical or tending to be symmetrical
WHO CLASSIFICATIONPAUCIBACILLARY- 5 or less than 5 lesions One thickened nerve SSS negative
MULTIBACILLARY - more than 5 lesions More than one thickened nerve SSS positive
LEPROMATOUS LEPROSYWell demarcated erythematous papules, and/or nodules ( non tender incontast to ENL where tender lesions are present and come with fever)LEONINE FACIES - body hair loss, especially of eyebrows and lashes and nodular thickening of earlobes lepromatous leprosy may present with diffuse infiltration and palpable thickening of the skin

3. Invasion of the mucosa of the nose may imitate nasal stuffiness, Septal perforation and/or collapse (saddle nose) may follow Asymptomatic, intermittent bacteremia occurs during lepromatous disease, during which M. leprae may develop focal lesions in various organs Other organs involved-testicles (reduced testosterone) larynx (hoarseness) NERVE ENLARGEMENT-involvement of nerves is late phenomenon in LL hansens Produce glove and stocking anesthesiaMOTOR weaknessAutonomic disturbances- produce dry cracked skin with loss of hair and loss of sweatingTrophic ulcers can developDeformities- eg claw hand foot drop
DIAGNOSIS1) clinical diagnosis- skin lesions,thickened nerves sensory motor examinations dry atrophic skin, trophic ulcersdeformities2) SSS- 6 sites ( 2 eyebrows,2 ears, one chin , 1 left buttock in males,thigh females)Now a days consensus is that the number of sites should be reduced to three prevent trauma to patient and also to reduce the risk of transmission of needle borne diseases to doctorzn stain3) histopathology – fite stain

4. 4) lepromin test5) tests to determine reduced sweating-pilocarpine test,histamine sweat testTreatmentMBMDT- ( red packet)Cap rifampicin 600 mg supervised once a monthCap clofazimine 300 mg supervised once a monthCap clofazimine 50 mg dailyCap dapsone 100 mg daily