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Hansen's Disease (Leprosy)

A progressive disease affecting the skin, peripheral nerves, and limbs. If untreated, it causes permanent tissue damage.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

About Hansen's Disease

Leprosy (Hansen's Disease) is a chronic infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa (lining of the nose).

The disease is caused by a bacillus (rod-shaped) bacterium known as Mycobacterium leprae.

At the beginning of 2010, the registered prevalence of leprosy in the world was 211,903 cases, and 244,796 new cases were detected during 2009, as reported by 141 countries (World Health Organization [WHO]). Since the 1980s, when the WHO initiated its Leprosy Elimination Project, more than 14 million cases have been cured.
NIH - National Institute of Allergy and Infectious Diseases

What works? Research summarized

Evidence reviews

Decompressive surgery for treating nerve damage in leprosy

Leprosy is a chronic infectious disease. Leprosy bacteria cause damage to skin and peripheral nerves which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage although its effect is uncertain. Two randomised controlled trials (RCTs) were included in the review and examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. Both trials were at high risk of bias. Two years from the start there was very low quality evidence of no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. No additional trials were identified when searches were updated in 2010 and 2012. Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well‐designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

Interventions for skin changes caused by nerve damage in leprosy

Three million persons are affected by nerve damage caused by leprosy (Hansen's disease) worldwide. Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae. About 30% of people with leprosy develop nerve damage that can lead to loss of normal sensation and skin damage. The skin can crack and become infected and ulcerated. Impairment of the affected limb, caused by nerve damage, can result in severe joint deformity and injuries. The major areas affected by sensory loss are the hands (especially the palms), feet (especially the soles) and eyes. The drug therapy offered to those with leprosy is efficacious and has low relapse rates. However, even with treatment, many with leprosy will go on to develop secondary damage to skin and limbs as the nerve damage sustained cannot be reversed. In some, treatment leads to inflammatory reactions in the nerves, sometimes resulting in further damage.

Interventions to treat erythema nodosum leprosum, a complication of leprosy

Leprosy remains a public health issue in poorer parts of the world. In 2007 there were approximately 255,000 new cases reported worldwide. Leprosy (or Hansen's disease) is a chronic infectious disease. The skin and peripheral nerves of people with leprosy contain leprosy bacteria. Leprosy can be cured with a combination of antibiotics. The immune system plays an important role in leprosy and determines if and how the disease will develop. The response of the immune system to the antigens of the leprosy bacteria may cause periods of inflammation in the skin and nerves, called reactions. Reactions are the main cause of acute nerve damage and disability in leprosy and occur in about one third of people with leprosy. One type of reaction is erythema nodosum leprosum (ENL), a serious and often chronic complication of leprosy caused by the immune system. People with ENL have red, painful swellings in the skin and often feel ill due to fever and general malaise. There are several treatments for ENL, including the oral drugs prednisolone, thalidomide, and clofazimine. We undertook a systematic review on this topic as it was not clear which treatments were most beneficial.

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Summaries for consumers

Decompressive surgery for treating nerve damage in leprosy

Leprosy is a chronic infectious disease. Leprosy bacteria cause damage to skin and peripheral nerves which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage although its effect is uncertain. Two randomised controlled trials (RCTs) were included in the review and examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. Both trials were at high risk of bias. Two years from the start there was very low quality evidence of no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. No additional trials were identified when searches were updated in 2010 and 2012. Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well‐designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

Interventions for skin changes caused by nerve damage in leprosy

Three million persons are affected by nerve damage caused by leprosy (Hansen's disease) worldwide. Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae. About 30% of people with leprosy develop nerve damage that can lead to loss of normal sensation and skin damage. The skin can crack and become infected and ulcerated. Impairment of the affected limb, caused by nerve damage, can result in severe joint deformity and injuries. The major areas affected by sensory loss are the hands (especially the palms), feet (especially the soles) and eyes. The drug therapy offered to those with leprosy is efficacious and has low relapse rates. However, even with treatment, many with leprosy will go on to develop secondary damage to skin and limbs as the nerve damage sustained cannot be reversed. In some, treatment leads to inflammatory reactions in the nerves, sometimes resulting in further damage.

Interventions to treat erythema nodosum leprosum, a complication of leprosy

Leprosy remains a public health issue in poorer parts of the world. In 2007 there were approximately 255,000 new cases reported worldwide. Leprosy (or Hansen's disease) is a chronic infectious disease. The skin and peripheral nerves of people with leprosy contain leprosy bacteria. Leprosy can be cured with a combination of antibiotics. The immune system plays an important role in leprosy and determines if and how the disease will develop. The response of the immune system to the antigens of the leprosy bacteria may cause periods of inflammation in the skin and nerves, called reactions. Reactions are the main cause of acute nerve damage and disability in leprosy and occur in about one third of people with leprosy. One type of reaction is erythema nodosum leprosum (ENL), a serious and often chronic complication of leprosy caused by the immune system. People with ENL have red, painful swellings in the skin and often feel ill due to fever and general malaise. There are several treatments for ENL, including the oral drugs prednisolone, thalidomide, and clofazimine. We undertook a systematic review on this topic as it was not clear which treatments were most beneficial.

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Terms to know

Bacteria
A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.
Mycobacterial Infections
Serious diseases, including tuberculosis and leprosy. Most mycobacteria are susceptible to antibiotics, but antibiotic-resistant strains have emerged.
Peripheral Nerves
The nerves outside of the brain and spinal cord.
Respiratory System
The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs. Also called respiratory tract.
Skin
The outer covering of the body that protects it from the environment.

More about Hansen's Disease

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Also called: Mycobacterium leprae infection

Other terms to know: See all 5
Bacteria, Mycobacterial Infections, Peripheral Nerves

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