Diagnosis, Treatment, and Stigma of Leprosy in Dermatology

Conclusions

• Leprosy remains an important cause of morbidity in the United States and globally, despite being less commonly considered in modern dermatology practice.
• The central clinical lesson is that leprosy should be suspected when skin lesions are accompanied by sensory loss, peripheral nerve enlargement, or anhidrosis, especially in patients from endemic areas.
• Diagnosis is often delayed because paucibacillary disease can be smear- and PCR-negative, so clinical-pathologic correlation is essential.
• Pathology, slit-skin smear, PCR, and ultrasound each contribute to diagnosis, but none alone is sufficient in every case.
• Clinicians should explicitly tell the pathologist when leprosy is suspected, because otherwise post-bacillary cases may be missed.
• Delayed diagnosis leads to preventable irreversible nerve damage, disability, blindness, and deformities such as claw hand.
• Multidrug therapy with rifampicin, dapsone, and clofazimine remains the standard treatment, with duration determined by paucibacillary versus multibacillary disease.
• Treatment must be individualized because dapsone can cause anemia and severe hypersensitivity, while clofazimine may cause stigmatizing skin pigmentation.
• Alternative regimens and newer bactericidal agents may expand future treatment options, but stronger clinical evidence is still needed.
• Improving clinician education and reducing stigma are necessary to prevent missed diagnoses and the social harms of leprosy.