Leprosy is an infectious disease caused by Mycobacterium leprae that is most prevalent in developing countries like India, Brazil, and Indonesia. It is spread through respiratory droplets, skin-to-skin contact, and possibly the gastrointestinal route. Leprosy exists on a spectrum from tuberculoid to lepromatous forms based on immunity and bacterial load. Lepromatous leprosy specifically presents with well-demarcated skin lesions and nodules, facial disfigurement, nasal stuffiness from mucosa invasion, and nerve involvement leading to sensory loss, weakness, and deformities over time if untreated. Diagnosis involves clinical examination, skin smear tests, histology, and treatment involves

1. LEPROMATOUS LEPROSY
INTRODUCTION
Leprosy (also known Hansen's disease) is an infectious disease caused by Mycobacterium leprae
EPIDEMIOLOGY
developing settings; countries with high numbers of cases include India, Brazil, Indonesia, Bangladesh
Poor housing conditions
Overcrowding play role
MODES OF TRANSMISSION
Not known
probably spread by the respiratory route
skin to skin contact
gastrointestinal route
CLASSIFICATION
RIDLEY JOPPLING CLASSIFICATION
tuberculoid (TT),
borderline tuberculoid (BT),
mid-borderline (BB),
borderline lepromatous (BL),
lepromatous (LL), and
Indeterminate
Patients on Tuberculoid end-
Good immunity

2. Few bacilli
Lepromin positive
Large and few lesions
Patients on lepromatous end
Poor immunity
Many bacilli
Lepromin negative
Large number of lesions
Small lesions
Symmetrical or tending to be symmetrical
WHO CLASSIFICATION
PAUCIBACILLARY- 5 or less than 5 lesions
One thickened nerve
SSS negative
MULTIBACILLARY - more than 5 lesions
More than one thickened nerve
SSS positive
LEPROMATOUS LEPROSY
Well demarcated erythematous papules, and/or nodules ( non tender incontast to ENL where tender
lesions are present and come with fever)
LEONINE FACIES - body hair loss, especially of eyebrows and lashes and nodular thickening of
earlobes
lepromatous leprosy may present with diffuse infiltration and palpable thickening of the skin

3. Invasion of the mucosa of the nose may imitate nasal stuffiness,
Septal perforation and/or collapse (saddle nose) may follow
Asymptomatic, intermittent bacteremia occurs during lepromatous disease, during which M. leprae may
develop focal lesions in various organs
Other organs involved-
testicles (reduced testosterone)
larynx (hoarseness)
NERVE ENLARGEMENT-involvement of nerves is late phenomenon in LL hansens
Produce glove and stocking anesthesia
MOTOR weakness
Autonomic disturbances- produce dry cracked skin with loss of hair and loss of sweating
Trophic ulcers can develop
Deformities- eg claw hand foot drop
DIAGNOSIS
1) clinical diagnosis-
skin lesions,
thickened nerves
sensory
motor examinations
dry atrophic skin,
trophic ulcers
deformities
2) SSS- 6 sites ( 2 eyebrows,2 ears, one chin , 1 left buttock in males,thigh females)
Now a days consensus is that the number of sites should be reduced to three prevent trauma to patient
and also to reduce the risk of transmission of needle borne diseases to doctor
zn stain
3) histopathology – fite stain

4. 4) lepromin test
5) tests to determine reduced sweating-pilocarpine test,histamine sweat test
Treatment
MBMDT- ( red packet)
Cap rifampicin 600 mg supervised once a month
Cap clofazimine 300 mg supervised once a month
Cap clofazimine 50 mg daily
Cap dapsone 100 mg daily