Leprosy: It’s treatable, it's curable

By Kumudini Hettiarachchi

A patch lighter than the colour of your skin or nodules or plaques which may be skin-coloured……don’t ignore them, for they may be the first signs of leprosy. Leprosy, that feared and dreaded disease since Biblical times when those who contracted it were isolated in colonies and had to ring a bell if they approached the town or the village is not what it was, MediScene learns.

It is treatable and curable, stresses Consultant Dermatologist Dr. Indira Kahawita who is attached to the Polonnaruwa General Hospital, explaining that even if there is a slight suspicion that you or a loved one have leprosy, you should see a dermatologist immediately.

Don’t scoff it off as aluham but consult a skin doctor. The sooner you seek treatment the better for you as well as those around you, urges Dr. Kahawita, pointing out that it is not a dreaded disease, for she treats all those who come to her with leprosy without wearing a mask and also touching the lesions without fear. She should know because she treats around 150 men, women and children with leprosy every year.

Leprosy caused by the micro-organism Mycobacterium leprae can come in two forms, MediScene understands.

  • Non-infectious leprosy – This commoner form of leprosy manifests as a patch of skin lighter than the surrounding area, with reduced or complete loss of sensation (feeling). The loss of feeling is so acute that if an injury or burn is sustained there, the person will not even know. This lighter-coloured skin patch is also different to other areas when touched. Contrasting these patches with aluham, Dr. Kahawita explains that in non-infectious leprosy, the person will develop only a few patches while in aluham there will be multiple (many) patches.
  • Infectious leprosy – This less common form of leprosy manifests as nodules (lumps and bumps) or plaques. While these palpable lesions may be the same colour as the skin, there may also not be a sensory loss on them.

Before the nodules and plaques surface, the facial appearance of the person infected by leprosy may change drastically, points out Dr. Kahawita, adding that he/she may lose the eyebrows. Nodules also come in the ears.

The tragedy, according to this Dermatologist, is that many young people who develop numbness in the hands and the feet, sometimes with either two or all five fingers in a hand getting clawed or with the inability to lift up a foot (foot-drop) may not have been diagnosed with leprosy.Ten to 11% of the total number of cases of leprosy are children between the age-group 0-14 years, it is understood.

Referring to the prevalence of leprosy, Dr. Kahawita says that it is found all along the coastal belt from Puttalam on the west to Batticaloa on the east. There have been no data from the Northern Province due to the conflict but now that situation will change.

Inland, Polonnaruwa seems to have the highest number percentage-wise, it is learnt because most people living in this area are settlers from the southern coastal-belt. Moratuwa is a well-known pocket for leprosy, MediScene understands, with cases now being detected also from Panadura and Kalutara as well as Piliyandala, with people migrating to these areas from Moratuwa.

There is nothing to fear and multi-drug therapy is available for both non-infective and infective leprosy, says this doctor. Two types of drugs daily for six months are prescribed for those with non-infective leprosy, while the regimen of three drugs per day for 12 months is the answer for infective leprosy. “The medication comes in a handy blister pack and has very few side-effects. Even infants and expectant or breastfeeding mothers can take these drugs as they have very few contraindications.”

When asked about disfigurement and deformity, she explains that due to the lack of sensation there can occur injuries similar to those in diabetics. Citing an example, she says if a person with leprosy rides a motorcycle, he can get burnt for the silencer, but it will heal. However, if a farmer gets a thorn-prick under his toes, it can become infected without him feeling it. The flesh wound will then spread to the bone and infect it as well, resulting in the bone becoming shorter, leaving that area disfigured or deformed. That’s why people say that toes and fingers halenawa (fall off).

Leprosy is transmitted through droplets from the nose and the mouth of the infected person to others who come into close contact with him/her, says Dr. Kahawita pointing out the need to screen the whole family if one member is detected with the disease.

Below “elimination level”

The prevalence of leprosy in Sri Lanka is less than 1 per 10,000 people which is about 0.7%, says the Director of the Anti-Leprosy Campaign Dr. Kumara Wickremasinghe when contacted by MediScene, adding that this is below the “elimination level” declared by the World Health Organization (WHO).

We have around 1,900 new cases per year, he says. The figure has been below 2,000 for many years. There are still pockets in the Western Province especially in the Colombo district. Cases with deformities come about due to a delay in diagnosis.

The Anti-Leprosy Campaign coordinates activity across the country including sending out mobile clinics. All districts have a Dermatologist while the Central Leprosy Clinic is at Room 21 of the National Hospital in Colombo.

Some positive pointers

The redeeming features of this disease, according to Dr. Indira Kahawita are:

  • The infectivity through the leprosy bacterium takes place very, very slowly. When taking a line-up of known bacteria, the leprosy bacterium is right at the bottom. It doesn’t jump at you.
  • Even when exposed to the leprosy-causing bacterium, 90% of the people have an inherent resistance to the disease.
  • If diagnosed early, complete recovery can be assured.
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