Chronic infectious disease caused by the acid-fast bacteria Mycobacterium leprae and M lepromatosis, characterized by skin lesion(s) and involvement of peripheral nerves.
Skin lesions can be erythematous or hypopigmented, single or multiple macules, papules, or nodules, sometimes with loss of sensation.
Skin smear may or may not be positive for acid-fast bacilli (AFB) depending on the classification (multibacillary vs. paucibacillary).
Nerve damage to peripheral nerve trunks may occur, with loss of sensation in the skin and weakness of muscles supplied by the affected nerve, leading to disabilities.
Diagnosis is most commonly based on clinical signs and symptoms, and in practice, people usually report on their own to the health center.
The standard WHO-recommended treatment for leprosy is with multidrug therapy.
Leprosy (also known as Hansen disease) is a chronic infectious disease characterized by one or more of the following features: hypopigmented or erythematous skin lesion(s) with loss of sensation; involvement of the peripheral nerves, as demonstrated by loss of sensation, paresthesias (tingling of hands and feet), and weakness of the muscles of hands, feet, or face.
History and exam
Key diagnostic factors
- typical skin lesions
- nerve involvement
- sensory loss
Other diagnostic factors
- immunologic reactions
- eye lesions
- close contact with a multibacillary leprosy patient
- residence in endemic area
- genetic predisposition
- zoonotic transmission
1st investigations to order
- skin smear
- skin and/or nerve biopsy and histopathology
Investigations to consider
- polymerase chain reaction
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)
Maria T. Ochoa, MD
Clinical Professor of Dermatology
USC Keck School of Medicine
Department of Dermatology
MTO declares that she has no competing interests.
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.
Hubert Sansarricq, MD
Member of World Health Organization Panel of Experts on Leprosy
HS declares that he has no competing interests.
David M. Scollard, MD, PhD
National Hansen's Disease Programs
DMS declares that he has no competing interests.
Alexandre Tiendrebéogo, MD, MPH
Leprosy and Neglected Tropical Diseases in Central Africa Countries
World Health Organization
Country Office of Kinshasa
DR of Congo
AT declares that he has no competing interests.
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- Guidelines for the diagnosis, treatment and prevention of leprosy
- Global Leprosy Strategy 2016-2020: accelerating towards a leprosy free world
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