Summary
Definition
History and exam
Key diagnostic factors
- typical skin lesions
- nerve involvement
- sensory loss
Other diagnostic factors
- immunologic reactions
- eye lesions
Risk factors
- close contact with a person with multibacillary leprosy
- poverty
- residence in endemic area
- genetic predisposition
- zoonotic transmission
Diagnostic tests
1st tests to order
- skin smear
- skin and/or nerve biopsy and histopathology
Tests to consider
- polymerase chain reaction
Treatment algorithm
multibacillary (MB) or paucibacillary (PB): no rifampin or fluoroquinolone resistance
multibacillary (MB) or paucibacillary (PB): rifampin ± fluoroquinolone resistance
type 1 reaction (reversal reaction)
type 2 reaction (erythema nodosum leprosum)
Lucio phenomenon
Contributors
Authors
Maria T. Ochoa, MD
Clinical Professor of Dermatology
USC Keck School of Medicine
Department of Dermatology
Los Angeles
CA
Disclosures
MTO declares that she has no competing interests.
Acknowledgements
Dr Maria T. Ochoa would like to gratefully acknowledge Dr Denis Paul Jacques Daumerie, a previous contributor to this topic. DPJD declares that he has no competing interests.
Peer reviewers
Hubert Sansarricq, MD
Member of World Health Organization Panel of Experts on Leprosy
Saint-Armour Morlaas
France
Disclosures
HS declares that he has no competing interests.
David M. Scollard, MD, PhD
Chief
Clinical Branch
National Hansen's Disease Programs
Baton Rouge
LA
Disclosures
DMS declares that he has no competing interests.
Alexandre Tiendrebéogo, MD, MPH
Medical Officer
Leprosy and Neglected Tropical Diseases in Central Africa Countries
World Health Organization
Country Office of Kinshasa
DR of Congo
Disclosures
AT declares that he has no competing interests.
References
Key articles
World Health Organization. Towards zero leprosy. Global leprosy (Hansen’s Disease) strategy 2021-2030. Apr 2021 [internet publication].Full text
World Health Organization. Implementation of MDT. In: Multidrug therapy against leprosy: development and implementation over the past 25 years. Geneva: World Health Organization; 2004:45-68.Full text
World Health Organization. Guidelines for the diagnosis, treatment and prevention of leprosy. Oct 2018 [internet publication].Full text
World Health Organization. Leprosy/Hansen disease: management of reactions and prevention of disabilities. 2020 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Psoriasis
- Eczema
- Tinea corporis
More DifferentialsGuidelines
- Towards zero leprosy. Global leprosy (Hansen’s Disease) strategy 2021-2030
- Leprosy/Hansen disease: contact tracing and post-exposure prophylaxis
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer