What are the symptoms of leprosy?

Updated: Jun 05, 2020
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Symptoms are as follows:

  • Painless skin patch. Chronic insensate patch is seen in the image below.

    Chronic insensate patch due to leprosy infection. Chronic insensate patch due to leprosy infection. Ho Chi Minh City, Vietnam. Courtesy of D. Scott Smith, MD.
  • Loss of sensation or paresthesias where the affected peripheral nerves are distributed

  • Wasting and muscle weakness

  • Foot drop or clawed hands (may result from neuritic pain and rapid peripheral nerve damage; as seen in the image below)

  • Characteristic clawed hand deformity caused by uln Characteristic clawed hand deformity caused by ulnar involvement in leprosy. Daloa, Ivory Coast. Courtesy of D. Scott Smith, MD.
  • Ulcerations on hands or feet (ulcer at the metatarsal head is seen in the image below)
  • Chronic nonhealing ulcer at the metatarsal head re Chronic nonhealing ulcer at the metatarsal head resulting from loss of sensation in the feet. Karigiri, Tamil Nadu, India. Courtesy of Tara Ramachandra.

Ridley-Jopling classification  [14]

Signs and symptoms of tuberculoid leprosy include the following:

  • Painless pale or red skin lesions with loss of sensation; lesions become raised as the disease progresses
  • A few affected nerves with diminished sensation and burning or tingling sensations
  • Significant sensory loss early in the disease course
  • Milder disease and fewer bacteria

Signs and symptoms of lepromatous leprosy include the following:

  • Painless pale or red skin lesions without loss of sensation; lesions become raised as the disease progresses
  • Thickening of peripheral nerves with diminished sensation and burning or tingling sensations
  • Extensive sensory loss over a longer period
  • More severe disease and larger numbers of bacteria
  • Facial deformities and paralysis
  • Involvement of eyes, bones, and other tissues

WHO Classification

The WHO Classification of leprosy is as follows:

  • Multibacillary: More skin lesions
  • Paucibacillary: Fewer skin lesions
  • Single-lesion paucibacillary: Single skin lesion

Symptoms in reactions

Symptoms in reactions are as follows:

  • Type 1 (reversal) - Sudden onset of skin redness and new lesions

  • Type 2 (erythema nodosum leprosum [ENL]; as seen in the image below) - Many skin nodules, fever, redness of eyes, muscle pain, and joint pain (seen in lepromatous leprosy only) [14]

  • Lucio phenomenon - Multiple ulcers

Patient with erythema nodosum leprosum type 2 reac Patient with erythema nodosum leprosum type 2 reaction several weeks after initiation of drug therapy. This photograph was taken after tendon release. Redwood City, California. Courtesy of D. Scott Smith, MD.

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