Classic features of leprosy include erythematous or hypopigmented plaques and alopecia. Clinically, leprosy can resemble tinea, contact dermatitis, vitiligo, pityriasis alba and myxedema. Diagnosis in the United States is often delayed because clinicians are unaware of the disease and symptoms.2,4
Leprosy can be classified according to the Ridley-Jopling system, which places the symptoms on a spectrum of disease that includes lepromatous, borderline-lepromatous, borderline-tuberculoid, tuberculoid and indeterminate classification. Lepromatous lesions are symmetrical and include nodules or macules. Borderline tuberculoid involves three to 10 lesions with satellites. Tuberculoid leprosy involves one to three sharply outlined, dry, flaky, hairless and erythematous or hypopigmented plaques. The World Health Organization simply defines leprosy cases as multibacillary (including lesions similar to lepromatous classes) and paucibacillary (encompassing the remaining categories). A leprosy case with only one hypopigmented macule that may be poorly defined is deemed indeterminate.2,4
Treatment with a multidrug regimen of rifampin (Rifadin, Rimactane), dapsone and clofazimine (Lamprene) taken daily for two years has been shown to be highly successful. Patients are noninfectious after a week and do not need to be isolated from work or family. The National Hansen’s Disease Program in Baton Rouge, La., offers therapy for patients and aids clinicians in the appropriate follow-up. Clients are typically monitored every three months.2,4,5
Mr. B has begun his two-year therapy regimen and will be monitored closely. It is critical for clinicians to be aware that leprosy continues to occur in the United States; consideration of this condition in the differential diagnosis the the key to successful diagnosis and treatment.
Ms. Weltin an assistant professor of nursing at Clarke University in Dubuque, Iowa.
4. Anderson H, Stryjewska B, Boyanton BL, Schwartz MR. Hansen disease in the United States in the 21st century: a review of the literature. Arch Pathol Lab Med. 2007;131:982-986.
All electronic documents accessed July 15, 2011.