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Hansen's Disease

Hansen's disease is an infectious skin disease that is chronic which affects the peripheral nerves, nasal mucosa, skin, eyes and upper respiratory tract. Hansen's disease, also known as Leprosy an infectious disease causes severe skin sores that can be disfiguring and may also cause nerve damage in the arms and legs. The disease is assumed to spread via nasal droplets or through broken skin or through secretions from the infected person's body that may contain the bacteria. Hansen's disease is not contagious and does not spread by merely coming in contact with the infected person.


Hansen's disease has been reported since ancient times and each culture across the world had a different understanding of the condition. Indians, Chinese and the Egyptians felt it was a contagious disease that was incurable. The outlook towards the disease has changed in the recent past. If the condition is diagnosed at an early stage and treated, it is curable. Though not completely eradicated, the disease has become rare and the number of cases of leprosy have reduced. Reported cases are from parts of Africa, Asia and very few cases in America.


Hansen's disease cause

A slow growing bacterium called Mycobacterium Leprae causes the condition. Leprosy is also called Hansen's disease named after the scientist who discovered the bacteria that caused the condition.


Hansen's disease symptoms

The skin and the peripheral nerves (nerves outside the brain and spinal cord) are largely affected by this condition. The nasal mucosa, eyes and upper respiratory tract also get affected. It takes about 3-5 years for symptoms to appear from when the person has come in contact with the bacteria.


  • Disfiguring skin sores that are pale in color
  • Lumps or bumps on skin
  • Thick, stiff and dry skin
  • Numbness in affected part of the skin
  • Eye problems like reduced blinking and dryness
  • Nosebleeds
  • Ulcers on sole of feet
  • Enlarged nerves

Hansen's Disease Types

Depending on the number of skin sores and its type, leprosy can be classified into the following types:

Lepromatus: A severe form of the disease that has extensive skin bumps and rashes. Kidneys, nose and male reproductive organs get affected. Muscle weakness and numbness is also felt. This type is more contagious.

Tuberculoid: This is a mild form of leprosy; people with this type have flat and pale colored patches on the skin. The pale colored patches on the skin may feel numb due to the nerve damage beneath the skin. This type of leprosy is less contagious.

Borderline: People suffering from this type of leprosy have symptoms of both lepromatus and tuberculoid.

Mid-borderline: Asymmetrically distributed reddish plaques can be seen. Swollen lymph nodes may also be seen; they either regress or progress to other forms of leprosy.

Indeterminate: A few hypo-pigmented macules may be seen; they either heal or progress to become other forms of leprosy.


Hansen's disease diagnosis

Diagnosis is based on the clinical symptoms such as localized skin lesions and sensory loss. Skin biopsy is done. A skin smear test may also be done. Without taking proper treatment, this disease can cause severe complications like:


  • Glaucoma or blindness
  • Infertility in men
  • Kidney failure
  • Disfiguration of the face
  • Nerve damage
  • Muscle weakness
  • Damage to nasal mucosa

Hansen's disease treatment

It is a myth that leprosy cannot be treated. For the past two decades, over 16 million people with leprosy have been treated. WHO offers free treatment for people suffering from leprosy. Treatment of leprosy depends upon the type. Treatment includes:


Antibiotics: Antibiotics cannot cure the nerve damage caused from the disease.

Thalidomide, a potent medicine is prescribed to suppress the immune system of the body. This drug helps to treat the skin nodules in leprosy. Anti-inflammatory drugs are provided to combat inflammation and pain.


Hansen's disease Facts


  • Hansen's disease progresses slowly - however progressively to affect the skin and nervous system.
  • Leprosy is not contagious and is not acquired by sitting next to the affected person.
  • Early symptoms of the disease begin in the cooler areas of the body (eyes, earlobes, nose) and later go on to cause loss of sensation.
  • Leprosy can get very damaging if left untreated; it can disfigure the face too.
  • Some people are genetically vulnerable to this disease.
  • There is no commercially available vaccine that can prevent leprosy.
  • 500,000 to 700,000 new leprosy cases are reported every year worldwide. Most of the cases are found in the tropics and the sub-tropics like Indonesia, Brazil, India.
  • The incubation period of the disease may vary from 6 months to 40 years.
  • Apart from humans chimpanzees, mangabey monkeys and nine-banded armadillos may also transmit the infection.
  • More than 95% of the human population has a natural immunity to the disease.
  • When treated at the right time, most cases of Hansen's disease respond to the treatment and become non-infectious within a short span of time.

Thalidomide

Certain skin conditions like Multiple Myeloma (a type of Cancer due to abnormal plasma cells), Hansen's disease (Leprosy) can be treated or the symptoms mitigated using thalidomide. It reduces redness and inflammation in Hansen's disease. It reduces the formation of blood vessels that feed tumors and thus is used extensively in cancer treatment. Thalidomide is an immunomodulatory agent. It works on the immune system to decrease certain substances that cause skin inflammation. Thalidomide is also prescribed for treatment of Sarcoidosis, HIV and Crohn's disease.


Thalidomide as a drug was primarily developed and used as a sedative to treat insomnia, anxiety and tension. The drug is also known as Asmaval, Valgis, Tensival, Distaval Forte and Valgraine. The drug that was popular as a wonder drug was banned in the early 1960s as it was found to cause deformity in children born to mothers who consumed this drug. Thalidomide caused severe to life threatening birth defects when either the father or mother consumed it during the time of fetal conception. Studies prove that this drug did cause birth defects in body parts like the eyes, face, heart, legs, bones and ears. Thalidomide blocked the formation of blood vessels thereby limiting blood flow and creating limbless babies.


In the 1970s thalidomide was used to treat leprosy. Later it was used as an anti-angiogenic - to stop the formation of new blood vessels. The same property of the drug which caused birth defects actually played a vital role in shrinking tumors. Thalidomide is used to treat cancer as it:


  • Can block blood vessels and limit blood flow.
  • Stop growth of blood vessels that can feed cancerous growth in the body.
  • Stabilize blood flow around the site of the tumor.
  • Once blood flow is stabilized around the tumor affected area, treatments like chemotherapy reach more effectively to the affected area.
  • Thalidomide also plays a role in preventing cancer from recurring, post chemotherapy.

Using Thalidomide

This medication should be taken orally. It is usually taken at bedtime, an hour after taking a meal. Handle the capsules with care; do not take them out of the blister pack if not being used immediately. Do not break the capsule. In case of skin contact with the powder, wash the area with soap and water. Hands should be washed thoroughly after handling the drug.

Pregnant women should not consume this drug. Doctors provide dosage based on the prevailing conditions, dosage should not be increased or decreased by the patient. Increase in dosage can cause serious side effects. Do not donate blood or sperm while on this drug. Avoid sexual contact while on this drug as the semen carries the drug in it. To get the maximum benefit of this drug, it has to be used regularly and should not be stopped suddenly. Stopping intake of the drug suddenly may worsen the condition.

While on this drug, make sure that your blood does not come in contact with any other person's blood. Thalidomide can make a person feel sleepy; hence alcohol should not be consumed while on this drug.


Thalidomide side effects

Side effects may vary from person to person. Common side effects include dizziness, chest pain, risk of blood clots, general weakness, racing heartbeat, dry skin, seizures and muscle cramps. Nerve damage may cause permanent damage in a few cases. Rare side effects include blood in urine, low blood pressure, reduced urination and fever without rash.



Leukoderma

Leukoderma or vitiligo as it is sometimes called, is a chronic skin condition that causes loss of pigment leading to pale spots of skin. Leukoderma can be described as an autoimmune skin disease where the body destroys its own pigment cells, melanocytes. After the pigment disappears, small or even larger areas of skin become white with sharp margins where they join unaffected parts of skin. The hair in these areas also grow white rather than pigmented. Leukoderma is more noticeable during summer when the normal skin darkens. The causes for leukoderma could be a combination of genetic and environmental factors. Inheritance seems to be a dominant trait for this condition.


Leukoderma may also occur at sites of injury to the skin and may show itself as scars or burns. Recent studies suggest that leukoderma could be caused by the development of an antibody to an enzyme in the pigment cell. Leukoderma may be caused due to several other factors as well - congenital as in tuberous sclerosis, partial albinism and Piebaldism and Waardenburg's syndrome. The immunological causes of leukoderma are Vitiligo and Halo mole. Thermal burns, Dermatitis or eczema and Psoriasis may also result in leukoderma. Infectious conditions such as Pityriasis versicolor, leprosy, lichen planus and syphilis could also result in leukoderma. Some occupational hazards that could cause leukoderma are exposure to depigmentation agents such as tertiary butyl phenol and exposure to chemicals.


The spots can spread, shrink or remain the same. It is often noticed that patches occur in symmetrical fashion across both sides of the body. Some times mild trauma to an area of skin can cause new spots as around ankles caused by friction due to shoes or sneakers. Corticosteroid ointment or cream of appropriate strength is used depending on the site involved. Normally a mild steroid is used on the face and a stronger one for the trunk and limbs. A specialized form of light treatment PUVA is also of value to some patients.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 15, 2019