Leprosy

Overview

Leprosy, also called Hansen's disease, is a long-lasting infection caused by a type of bacteria. It mainly affects the skin and the nerves just under the skin. Because it can damage nerves, people may lose feeling in parts of their hands, feet, or face. Leprosy is not a punishment, not a curse, and not a sign of poor hygiene. It is a medical condition that can be cured with treatment. Once a person starts treatment, they stop being able to pass the infection on.

Leprosy is rare in most of the world, but it still occurs in a number of countries in Asia, Africa, South America, and the Western Pacific. Around the world, roughly 200,000 new cases are reported each year, and most of these are in a small number of countries. In the UK and most of Europe, it is very uncommon and usually seen only in people who have lived in or travelled to areas where leprosy is more common.

Leprosy can affect anyone at any age, from young children to older adults. It is most often diagnosed in adults between about 20 and 40 years old. It is not linked to gender, wealth, or social status. People who live in the same household as someone with untreated leprosy have a higher chance of getting it, because it takes long, close contact to pass it on.

Symptoms

Common symptoms

• One or more flat patches of skin that are lighter, paler, or reddish compared with the surrounding skin
• Patches of skin that feel numb, or where you cannot feel a light touch, heat, or pain
• A patch of skin that has lost hair or sweat
• Numbness, tingling, or a burning feeling in the hands, feet, or face
• Swollen or tender nerves, sometimes felt as lumps or cords under the skin, especially near the elbow, knee, or neck
• Weakness in the hands, feet, or face, such as trouble holding things, tripping, or not being able to close one eye
• Painless cuts, blisters, or sores on the hands or feet that do not seem to heal
• A blocked or crusty nose, nosebleeds, or a sore inside the nose
• Thickened skin, or lumps on the face and ears in some types of leprosy

Symptoms in children

• Pale or reddish skin patches that are less sensitive to touch than the skin around them
• Numbness that a child may not notice or complain about, but that shows up when they do not react to a poke or a hot cup
• Weakness or a droopy eyelid, or trouble closing one eye
• Lumps or swelling near a nerve, which can be tender
• Because children often have fewer symptoms and may not be able to describe numbness, parents and carers may notice small injuries or burns that the child did not feel

Symptoms in older adults

• Symptoms may be mistaken for other nerve problems that are more common with age, such as diabetes-related nerve damage
• Skin patches may be less obvious on older skin, and may be put down to ageing or a skin complaint
• Long-standing numbness may only be noticed when a foot or hand injury appears
• Nerve pain or weakness may be wrongly blamed on arthritis or a trapped nerve, so it is worth mentioning any travel or residence in areas where leprosy is common

Causes

Main causes

• Leprosy is caused by a bacterium called Mycobacterium leprae (and a closely related one called Mycobacterium lepromatosis). These bacteria grow very slowly, so symptoms can take years to appear.
• The bacteria are passed from person to person through droplets from the nose and mouth, during long, close, repeated contact with someone who has untreated leprosy.
• It is not passed on by casual contact, handshakes, hugging, sharing meals, or sitting near someone.
• Most people who are exposed do not develop leprosy because their immune system is able to fight the bacteria off.

Risk factors

• Living in the same household for a long time with someone who has untreated leprosy
• Living in, or having spent long periods in, a country or region where leprosy is common
• Having a close relative with leprosy, which suggests a shared genetic susceptibility
• A weakened immune system from another illness or from some medicines that suppress immunity
• Poor living conditions and overcrowding, which make close contact more likely — this is about exposure, not about cleanliness or character
• Age — children and young adults are more often affected than older people

When to see a doctor

See a doctor urgently if:

• You notice a patch of skin that feels numb, or you cannot feel a light touch or a pinprick on it
• Weakness or numbness comes on in your hand, foot, or face, or gets worse over days or weeks
• A nerve feels swollen, tender, or painful
• You have a red, painful eye, or trouble closing one eye
• A sore, blister, or burn on your hand or foot is not healing, or looks infected
• You develop fever with painful skin patches or swollen nerves

Book a routine appointment if:

• You have a skin patch that is lighter, darker, or reddish compared with the rest of your skin and has not gone away after several weeks
• You have a patch of skin that has lost hair or is dry and cannot sweat
• You have had a blocked or crusty nose or repeated nosebleeds with no clear cause
• You have lived in or spent time in a country where leprosy is common and you are worried about a skin or nerve symptom
• Someone in your household or family has been diagnosed with leprosy — you should be checked even if you feel well

Diagnosis

A doctor or health worker will usually be able to recognise leprosy by talking to you and examining your skin and nerves. In many countries leprosy is diagnosed by a trained health worker at a local clinic, and the diagnosis can often be made without any laboratory tests at all. Because leprosy is uncommon in the UK and Europe, it is very helpful to mention any country you have lived in or visited, and for how long.

Tests that may be done

• A skin examination in good light, looking at the number, colour, and borders of any patches
• Testing sensation on skin patches with a light touch, a wisp of cotton, or a fine pin, to see whether feeling is reduced
• Feeling for swollen or tender nerves and checking muscle strength in the hands, feet, and face
• A skin slit smear test, where a tiny sample of skin is looked at under a microscope for the bacteria (not needed in every case)
• A skin biopsy, where a small sample of skin is removed and examined in a laboratory
• A polymerase chain reaction (PCR) test, a lab test that looks for the bacterium's genetic material, used in some centres
• Blood tests may be done to check your general health or to rule out other conditions, though there is no single blood test that confirms leprosy
• Screening of household contacts, which may include a skin check and asking about symptoms

What to expect at your appointment

The appointment is straightforward and not painful. The doctor will ask about your symptoms, your general health, and where you have lived or travelled. They will look closely at your skin and may test how well you can feel a light touch. Most of the examination can be done in an ordinary clinic room. If a skin sample is needed, the area is numbed first with a small injection, and you may have a tiny stitch. Some results come back within days, and others take a week or two. If leprosy is confirmed, you will be told clearly what it means and offered treatment, and the clinic will usually offer to check people you live with.

Treatment

Leprosy is treated with a combination of antibiotics, and it is curable. Treatment is almost always taken as tablets at home, not in hospital. The aim is to kill the bacteria, stop the infection spreading, protect the nerves, and prevent disability. In many countries this treatment is provided free through World Health Organization programmes.

Self-care at home

• Take your tablets exactly as prescribed, every day, and finish the full course even if you feel completely well — stopping early risks the infection coming back and nerves being damaged.
• Check your hands and feet every day for cuts, blisters, burns, or redness, because numbness means you may not feel an injury happening.
• Protect numb hands and feet: wear shoes rather than walking barefoot, use gloves for hot or sharp tasks, and test bath water temperature with a part of the body that has normal feeling.
• Moisturise dry skin, especially on the feet, to stop cracking that can let infection in.
• Keep up any exercises or physiotherapy you are taught to keep joints and muscles working.
• Attend your follow-up appointments, including eye checks, even if you feel fine.
• Ask your pharmacist or clinic before taking any other medicines or supplements, so they can check they are safe with your treatment.
• Limit alcohol while on treatment and ask your clinic for advice if you smoke, as both slow healing.

Medical treatments

Treatment usually involves a combination of two or three antibiotic medicines taken together for several months to about a year, depending on the type of leprosy. Using more than one medicine at once is important: it makes treatment much more effective and stops the bacteria becoming resistant to the medicines. Your clinic will explain exactly which medicines you need, how long to take them, and what side effects to watch for. Some people also need a short course of anti-inflammatory medicines (such as steroids) if their nerves become inflamed or painful — this is to protect the nerves, and it is prescribed and monitored by a doctor. Other medicines may be used to help with nerve pain. Eye problems may need drops or specialist care. No one should buy or start these medicines without medical advice.

When is surgery considered?

Surgery is not used to cure leprosy — the antibiotics do that. But surgery can sometimes help repair problems caused by nerve damage, such as clawed fingers, a dropped foot, or narrowed eyelids that cannot close. It may also be used to treat long-standing foot ulcers or to relieve pressure on a nerve. Surgery is usually considered after the infection has been treated and when the nerve damage has settled. Your specialist team would discuss whether it could help you.

Living with this condition

Most people with leprosy carry on with work, school, and family life as normal while taking treatment. The tablets are taken at home, and once treatment has started you cannot pass the infection to others, so there is no need to avoid people or be isolated. The main day-to-day focus is looking after your skin, hands, feet, and eyes, especially if you have numbness. Small daily habits — checking your feet, wearing shoes, and keeping skin moisturised — make a real difference to preventing injuries. Many people also find it helps to tell a trusted friend or family member about their diagnosis, so they have someone to talk to and someone who can help check their feet.

Lifestyle tips

• Build a short daily routine of checking hands and feet for cuts, redness, or swelling, using a mirror for the soles of your feet if needed.
• Wear well-fitting, comfortable shoes and socks, and check inside shoes for stones or rough seams before putting them on.
• Avoid walking barefoot, even indoors, if your feet are numb.
• Use gloves for cooking, gardening, and DIY, and use oven gloves for hot pans.
• Stop smoking if you can, and keep alcohol within low levels — both help healing and circulation. Ask your GP or pharmacist for support to quit.
• Keep up regular, gentle activity to maintain strength and joint movement.
• Keep going to any physiotherapy or hand and foot care appointments, and do the exercises at home.

Diet and exercise

There is no special leprosy diet, and no food or supplement cures or prevents the condition. Eating a balanced, varied diet with plenty of vegetables, fruit, beans, and protein helps your body heal and keeps your skin and nerves healthy. If you have lost weight without trying, or have trouble eating, mention it to your doctor. Gentle regular exercise — walking, stretching, and any movement or strength exercises your clinic has shown you — helps keep joints and muscles working. If you have numbness in your feet, choose well-cushioned shoes and check your feet after exercise for blisters or hot spots. Ask your healthcare team before starting a new exercise programme if you have existing nerve damage.

Mental health and emotional wellbeing

Leprosy has carried stigma for centuries, and many people feel shame, fear, or worry about being judged, even though the condition is curable and treatment stops it spreading. It is very common to feel anxious or low after a diagnosis, or to worry about work, relationships, and how others will react. These feelings are understandable and treatable. Talking to a counsellor, a support group, or a trusted person can help a lot. If you feel persistently low, hopeless, or unable to cope, please tell your doctor — effective help is available. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away, and stay with someone you trust until help arrives.

Prevention

Leprosy cannot be completely prevented, but the risk can be greatly reduced. The most important step is finding and treating people who have it early: once someone starts treatment, they no longer pass the bacteria to others. Checking people who live with someone who has leprosy is a key part of prevention, because it catches infection early. In some situations, doctors may offer a single preventive dose of medicine to close contacts of a person with leprosy, following national guidance. Good general health and a strong immune system help too, but leprosy is not caused by poor hygiene, so there is no special washing or cleaning routine that prevents it.

Vaccines

There is no vaccine that is made specifically for leprosy. The BCG vaccine, which is used mainly to protect against tuberculosis, may give some limited protection against leprosy, and it is used in some countries for that reason. Whether you have had BCG depends on where you grew up and your personal health history. If you are unsure, ask your GP or travel health clinic.

Screening programmes

There is no general population screening programme for leprosy. Instead, 'contact screening' is used: if someone is diagnosed with leprosy, health services will usually offer to check the people they live with and other close contacts for early signs. Contacts may also be checked again after a period of time, because symptoms can take years to appear. If you have lived in an area where leprosy is common and you have a numb patch or nerve symptoms, ask for a check even if no one else around you has been diagnosed.

Complications

If left untreated

• Permanent nerve damage, leading to lasting numbness in the hands, feet, or face
• Loss of feeling that allows injuries, burns, and blisters to go unnoticed, which can lead to infected ulcers
• Weakness or clawing of the fingers, a dropped foot, or difficulty closing the eyes
• Eye damage and, in serious cases, vision loss or blindness
• Stiff, shortened fingers or toes and changes in the shape of the nose or ears
• Painful immune reactions, where the body's response to the bacteria causes swollen, tender skin and nerves
• Social stigma, discrimination, loss of work, and strain on relationships and mental health

Long-term outlook

The outlook for people with leprosy is good. The infection can be cured with antibiotics, and once treatment begins the person cannot pass it on. If leprosy is found and treated early, most people recover fully with no lasting disability. Nerve damage that has already happened cannot always be reversed, but much can be done to protect the hands, feet, and eyes from further harm, and physiotherapy, special footwear, and sometimes surgery can help a great deal. Many people treated for leprosy go back to their normal work and family life. If you are worried, please speak to your healthcare team — they can tell you honestly what to expect for your situation.

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