Doctors advised to be on the look-out for leprosy
Doctors attending a leading medical conference this week are being informed that leprosy, commonly thought by the public to have been eradicated in the UK, is still present and may be masquerading as other more common skin diseases.
A team of dermatologists from Cardiff in Wales are issuing their advice to 1,300 doctors at the British Association of Dermatologists’ Annual Conference in Glasgow, after seeing two leprosy cases in their clinics that had originally been misdiagnosed as more common skin complaints.
Both cases, diagnosed at the University Hospital of Wales, were in men who had moved to the UK from Asia within the last few years. The first, aged 25, had been experiencing changes to his skin’s colour and sensation on the left side of his face for six months, and lightening of the skin on his right shoulder for a year. The symptoms on his face had been previously misdiagnosed as a skin infection called erysipelas, while the skin lightening was treated as a rash called pityriasis versicolor. The second man, aged 35, had scattered patches of skin lightening over his body, raised red areas called plaques on his forehead, and circular lesions on his legs. These lesions brought about changes in his skin’s sensation. He was initially diagnosed with a type of eczema called discoid eczema. Both men were subsequently diagnosed by dermatologists as having leprosy and referred to infectious disease specialists for appropriate treatment.
Also known as Hansen’s Disease, leprosy is a chronic infection caused by bacteria called Mycobacterium leprae and Mycobacterium lepromatosis. It is unusual in that symptoms can occur several years after initial infection, sometimes even decades later. It causes lesions on the skin and diminished or loss of sensation in the affected areas, which can eventually cause further complications. Leprosy is not highly contagious and it is not fully known how it is passed from person to person but it is thought to be via droplets from the nose and mouth. The spread of leprosy is caused by close and frequent contact between a person who is genetically susceptible to develop the disease, and an untreated contagious patient.
It is a relatively rare disease with approximately 232,000 cases reported annually worldwide, the majority of which occur in south-east Asia. 129 cases were reported in England and Wales between 2001 and 2010.
Dr Ausama Atwan, one of the reporting clinicians in Cardiff, said: “Our aim is not to alarm people unduly as leprosy is still uncommon in the UK, but it is certainly something that doctors should be mindful of if they encounter patients, especially those originally from endemic countries, with persistent or unexplained lesions, changes to skin pigmentation and sensation. Leprosy may masquerade as various other skin disorders, given its range of symptoms. Due to its rarity in Europe, it may easily be misdiagnosed and consequently pose future health risks for patients if missed. A detailed medical history, including factors like travel to areas where the disease is more common, and examination of the skin and peripheral nerves, together with a high degree of suspicion in individuals at risk, are crucial towards diagnosis and the eventual treatment of leprosy. The potential prolonged incubation period must also be borne in mind.”
Nina Goad of the British Association of Dermatologists said: “When people hear the term leprosy, they generally think of leper colonies and references to the disease in the Bible or films like Monty Python’s Life of Brian. They are probably not aware that it can still occur here in the UK. Diagnosis in western populations such as the UK is often delayed because doctors are unaware of the disease’s presence in their country, or of its symptoms. Dermatology is hugely underrepresented in GP training to start with, so rare diseases like leprosy are seldom taught. However, early diagnosis and treatment are crucial in limiting the nerve damage that causes the numbness that can in turn lead to loss of limbs or digits.”
The first known written mention of leprosy is dated 600 BC. Throughout history, leprosy patients have often been ostracized by their communities and families. This has led to the disease’s name commonly being used to represent social stigma and ostracization. Leper colonies were set up throughout the middle ages to quarantine patients, the vast majority of which have since closed.
In June this year, researchers in the US announced that they are developing a vaccine against the disease that is due to be trialled next year.
For more information please contact: Nina Goad, Head of Communications, 0207 391 6094 or mobile 07825567717 during conference week, or email: firstname.lastname@example.org, Website: www.bad.org.uk