Hansen's Disease (Leprosy)

For 3 years, a 53-year-old man had noted increasingly extensive changes in his skin, including facial thickening, a progressive reddish tinge, and annular lesions on his trunk. He also complained of itching on the periphery of his face.

Ill-defined, thickened plaques of the face-particularly on the forehead and cheeks-were evident (A). Brownish red annular plaques with prominent areas of central clearing covered the thickened skin of the abdomen (B and C). No scale was seen, and no nodes were palpable. The patient had good sensation over all the affected areas. The remainder of the physical examination was unremarkable.

Based on the presentation, Joe Monroe, PA-C, of Tulsa, Okla, considered mycosis fungoides, sarcoid, and leprosy in the differential. Multiple punch biopsies confirmed Hansen's disease, lepromatous type. Fite stains showed large numbers of Mycobacterium leprae organisms; this finding is typical of multibacillary disease. Paucibacillary, or tuberculoid, leprosy is characterized by few bacteria on Fite staining and is a less severe form of the disease.

Although multibacillary leprosy is contagious, patients do not pose a significant threat of transmission to most other adults. Approximately 95% of the world's population have a natural immunity to Hansen's disease.¹ However, long-term contacts, particularly family members, need to be monitored regularly for signs of the disease. The latency period (5 to 30 years before obvious symptoms appear) can obscure the patient's history, making it difficult to discover how and where the illness was contracted; such was the case with this patient.

Approximately 6500 Americans currently are known to have Hansen's disease; between 200 and 250 new cases are reported annually. Worldwide, the disease is most prevalent in Southeast Asia and Central Africa; in the United States, the largest number of cases occur in California, Hawaii, Louisiana, Florida, New York, Puerto Rico, and Texas,¹ where this patient had lived for many years.

This patient was referred immediately to the Hansen's disease treatment unit of the United States Public Health Service in Baton Rouge, La. Oral rifampin, clofazimine, and dapsone were prescribed. The patient was considered noncontagious after 3 days of treatment; he will continue the regimen for at least several years. He returned home and resumed his normal activities.

REFERENCE:1. National Hansen's Disease Programs. Frequently asked questions. Baton Rouge, La. Available at: http://bphc.hrsa.gov/nhdp/FAQS_MAIN_PAGE.htm. Accessed October 2, 2001.