Leprosy, Nepal, pictures

Leprosy PPT by Dr. PKB Agrawal 1

Case

A 28 years male presented with this lesion in his armfor 2 months.

What do you see??What do you ask??What do you examine??Differential diagnosis??

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Leprosy

By:Dr. Pawan KB Agrawal, MD

Consultant General Practitioner ,Bayalpata Hospital, Accham.8th November, 2016, Tuesday.

Dermatology Series

Leprosy PPT by Dr. PKB Agrawal 311/8/2016


Prevalence

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Introduction• a chronic infection caused by the acid-fast,

rod-shaped bacillus Mycobacterium leprae.

• primarily affect superficial tissues, especially the skin and peripheral nerves.

• highly stigmatized; visible debilities and sequelae

• probably spread by the respiratory route

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Presentation• Symptoms:

– patch with loss of sensation but not itchy (Loss of sensation in tuberculoid leprosy, unlike lepromatous leprosy, in which it is preserved.)

– Loss of sensation or paresthesias over distribution of affected peripheral nerves.

– Wasting and muscle weakness– Foot drop or clawed hands

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Presentation– Foot ulcers– Iridocyclitis, corneal ulcers

• Signs:– Thickened nerves

• Ulnar ; Superficial radial cutaneous; Median ; Common peroneal ; Great auricular .

– perineum, scalp, and axilla: not normally involved

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PB vs MB

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Ridley Jopling Classification• TL: sharply demarcated hypopigmented macule with

assymetric nerve involvement.• BT: few or moderate and asymmetric; peripheral nerves

often involved• BB: Moderate lesions; symmetric nerve involvement.• BL: Numerous lesions; symmetric nerve

involvement.• LL: symmetric involvement with numerous macules,

nodules, plaques, or papules; poorly defined borders and raised and indurated centers.

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Differentials• T. versicolor• T. corporis• P. rosea• Vitiligo• Diabetic neuropathy• Sarcoidosis• Secondary syphilis

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Diagnosis

• WHO:–one or more of the following:

• Hypopigmented or reddish skin lesions with loss of sensation

• Involvement of the peripheral nerves as demonstrated by their thickening and associated loss of sensation

• Skin smear positive for acid-fast bacilli11/8/2016


Investigations• Slit skin smear• Skin biopsy• CBC• RFT• LFT

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Treatment

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Treatment• Mainly 3 drugs:

– Dapsone, rifampin & clofazimine.

• Steroids may be helpful in severe pain with nerve involvement.

• ROM regimen for single PB lesion.

• Surgeries: reconstruction; cosmesis.

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Treatment• Response: The erythema and induration of

skin lesions diminish within a few months but may take few years.

• Follow up: first follow up in 2-4 weeks to evaluate side effects of medications thereafter routine follow-up every three months.

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THANK YOU>>

So, do you get your take home message??

Leprosy, Nepal, pictures

Health & Medicine

Transcript of Leprosy, Nepal, pictures