Leprosy mailing list – July 18th,
2006
Ref.: Can leprosy
skin lesions heal and disappear, under treatment, in 3-6 months?
From:
Ahmad L., Karachi, Pakistan
Dear Dr Salvatore,
Thanks, Dr Shen Jianping (LML
July 14th, 2006) has a point on indeterminate leprosy
and social aspect of 'declaring someone as a leprosy patient'. It is some times as
traumatic psychologically as 'declaring someone as HIV positive'.
In a single leprosy
lesion the clinician has to be very careful in declaring someone
as leprosy patient (leper in patient's mind) especially when it is
indeterminate (cannot be determined).
In TT, a skin biopsy is ideal, the
presence of a leprosy granuloma with clinically enlarged and
tender nerve give the diagnosis.
Nerve biopsy may also be satisfactory BUT, in
indeterminate leprosy, skin biopsy gives only 'benefit of the doubt' in
an endemic area. Mere
sub-epithelial perivascular infiltration of monocytes / histiocytes surrounded by lymphocytes occur in many other skin
conditions.
In practice what we can do is
to take such patients in confidence and inform them that they
are only going under a therapeutic trial for 3-6
months without enforcing your decision and without a registration
number for leprosy patient.
This is in practice in pulmonary tuberculosis where a primary
complex in chest x-ray is kept on therapeutic trial without declaring
him as a TB patient in TB endemic areas.
With regards,
Dr Latif Ahmad
P.S
Please accept my condolences on the sad demise of people killed in
recent blasts in Mumbai.
