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 Leprosy Nodules and Skin Lesions

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by the bacteria Mycobacterium leprae. It primarily affects the skin and nerves but can also affect other organs such as the eyes, nose, and mucous membranes causing Leprosy Nodules and Skin Lesions.

Leprosy is characterized by the formation of nodules and skin lesions. These manifestations are a result of the body’s immune response to the bacteria and the damage caused by the infection. The disease has a long incubation period, which can range from several months to many years, making it difficult to determine the exact time of infection.

Nodules are one of the primary clinical features of leprosy. Leprosy nodules are raised, reddish, or copper-colored swellings that usually appear on the skin’s surface. Nodules can vary in size and can be single or multiple. They are often painless and may persist for long periods. Nodules typically develop on cooler areas of the body, such as the earlobes, elbows, knees, and buttocks.

Skin lesions are another common manifestation of leprosy. They can present in various forms depending on the type and severity of the disease. The two major types of leprosy are paucibacillary (PB) and multibacillary (MB).

In paucibacillary leprosy, which is the milder form of the disease, the skin lesions are hypopigmented (lighter than the surrounding skin) and have well-defined borders. They may appear as macules (flat spots), papules (raised spots), or plaques (thickened areas). These lesions are usually few in number and predominantly affect the cooler parts of the body.

Multibacillary leprosy, on the other hand, is the more severe form of the disease. In this type, the skin lesions are erythematous (red) and often show poorly defined borders. They may be larger in size and can involve a greater surface area of the body. These lesions are more numerous and can occur in both cool and warm areas of the body.

It is important to note that leprosy is not highly contagious and is mainly transmitted through prolonged and close contact with untreated individuals. Early diagnosis and appropriate treatment with multidrug therapy (MDT) are crucial in managing leprosy and preventing complications.

 Objective of Leprosy Nodules and Skin Lesions

 To obtain four skin smears from the right ear-lobe, left ear-lobe, active lesion/elbow of the right arm, and another active lesion/lower right thigh.

Time Required: 15 minutes

Materials 

 Skin Smear of Leprosy Nodules and Skin Lesions

• Surgical Blade No. 15 (new/disposable)
• Surgical Handle No. 3
• Micro slide (new)
• Spirit swab
• Spirit lamp
• Swab stick
• Dry cotton
• Tincture of benzoin
• Match box
• Slide box
• Diamond pencil
• Forceps
• Gloves
• Register
• Requisition form

 Biopsy of Leprosy Nodules and Skin Lesions

• Blade No.15
• Handle No. 3
• Suture sate
• 0.2% xylocaine
• Sterile 5ml container

 Procedure

 Skin smear from the ears/arm/thigh/lesion

1. Before starting procedure, carefully explain it to the patient.
2. Clean slides and write the patient’s information on the slide.
3. Examine the patient’s ear in good light from the side and look for lesions.  Lesions appear as small swellings with a shiny surface, of different sizes.  Select the most congested lesion or nodule.  If no lesion is visible, take a specimen from the edge of the ear.
4. Clean the ear with cotton wool dipped in iodine, ethanol or spirit.  Fix the scalpel to the handle and pass the blade through the flame three times.  Do not heat the blade.
5. Keep dry cotton available to wipe away excess blood.  Squeeze the ear lobe very hard between your finger and thumb to stop the flow of blood to the area.  This is very important.
6. Squeezing very firmly, make a superficial incision lengthwise in the middle of the lesion, about 0.5cm long and 2-3mm deep.
7. Still squeezing scrape the bottom and sides of the incision with the point of the blade at right angles to the incision.  Collect on the blade the colourless serious matter from the lesion.  Do not draw blood.
8. After taking the sample place a piece of cotton wool soaked in tincture of benzoic on the incision.
9. With the flat of the blade spread the serious material in a circular motion over an area 5-7mm in diameter on a slide number with the patient’s reference.
10. Wipe the blade with cotton soaked in ethanol or spirit.  Pass the scalpel blade through the flame before taking the next specimen.
11. Leave the slide to dry in the air in a dust free place.  When dry fix by passing through the flame three times.
12. The above procedure is repeated on the same patient for specimens from other ear-lobe, an active lesion or the right arm and another active lesion or the right thigh.  All four specimens are placed on the same slide.

Biopsy

Clinicians perform an aseptic biopsy of the lesion site.  The sample is divided in half.  Half is placed in a tube with formalin to be sent to referral centre.  The other half is analyzed immediately or placed at 4°C.

Precautions

• Ensure that the blade does not become hot when passing it through the flame.
• Do no draw blood when taking samples.