Hansen's disease is a chronic granulomatous disease caused by Mycobacterium leprae that still poses challenges for clinicians because of its wide range of presentations, including atypical forms. Atypical manifestations of the disease-such as lazarine leprosy, psoriasiform leprosy, verrucous plaques, histoid leprosy, erythema livedoid plaques, Sweet's syndrome-like lesions and reactions resembling erythema multiforme or urticarial vasculitis and Lucio phenomenon-can mimic a variety of dermatological and systemic disorders, posing considerable diagnostic challenges, as reported in the literature. Misdiagnosis or delayed diagnosis is common, leading to preventable morbidity, disability, and ongoing transmission. This issue is further amplified in non-endemic areas where clinical suspicion is low. Variability in presentation is influenced by factors such as disease endemicity and host immune status. Unusual forms can obscure recognition. Some cases present with asymptomatic nodules, erythromelalgia, or spontaneous ulceration, further complicating diagnosis. A detailed clinical history, high diagnostic suspicion, and confirmatory investigations- including slit-skin smears and histopathology-are crucial for accurate diagnosis. Early identification of atypical leprosy presentations allows timely treatment, reduces complications, and limits disease spread. We present six cases of leprosy with unusual clinical manifestations, namely, secondary syphilis, hand ulcers, mycetoma, sporotrichosis, purpura fulminans and Sweet's syndrome. This case series emphasises the diverse clinical spectrum of leprosy and the need for heightened clinical awareness to avoid misdiagnosis, especially in atypical or rare presentations.
Background Painful neuroma and phantom-limb pain (PLP) are common, debilitating complications after lower-extremity amputation, yet their frequency in people with leprosy is largely unknown. Leprosy is associated with prolonged deafferentation, which may alter peripheral and central pain processing mechanisms, potentially reducing the risk of post-amputation pain. This study evaluated the expert-reported prevalence of painful neuroma and PLP in patients with leprosy who underwent below-knee amputations (BKA). Methods We conducted a cross-sectional, web-based survey between 06/2024 and 04/2025 involving 14 global leprosy specialists, each with over 10 years of clinical experience managing leprosy-related amputations. The structured questionnaire, distributed via REDCap, captured the estimated prevalence of painful neuroma and PLP in leprosy patients with BKAs, as well as comparative data from non-leprosy amputees managed by the same clinicians. Results All 14 respondents provided data on painful neuromas, and 11 provided data on PLP. Painful neuromas in leprosy amputees were reported at significantly lower rates than in non-leprosy amputees (p = 0.002), with most clinicians indicating frequencies in the 0-16% range. PLP was also skewed toward low prevalence, but the difference compared to non-leprosy patients was not statistically significant (p = 0.25). Conclusion Expert opinion suggests that leprosy-related BK amputees experience markedly fewer painful neuromas and modestly less PLP than amputees without leprosy. These findings suggest unique neuropathic adaptations in leprosy patients, possibly due to chronic deafferentation.
Leprosy self-care is essential for preventing disability and preserving dignity but remains challenging in resource-constrained settings like Nigeria. Traditional behavioural approaches often fail to address the broader social and material factors influencing self-care sustainability. This study employs Social Practice Theory (SPT) to reconceptualise leprosy self-care as a socially embedded practice, moving beyond individual-focused interventions. Conducted over four months in a leprosy-designated village in North Central Nigeria, the research utilised a qualitative methodology grounded in hermeneutic phenomenology. Data were collected through 20 in-depth interviews with individuals affected by leprosy, five key informant interviews, and 16 hours of non-participant observation. Thematic analysis, guided by SPT's framework of competences, materials, and meanings, revealed that self-care is shaped by dynamic interactions among skills, resource availability, and cultural interpretations. Challenges included inadequate supplies, inconsistent healthcare support, and stigma, which often undermined engagement. Religious practices and daily routines, such as ablution, sometimes supported self-care, while competing activities like street begging posed barriers. The study distinguishes between replaceable and irreplaceable materials, highlighting their impact on practice sustainability. Family and peer involvement further influenced outcomes, either reinforcing or weakening self-care efforts. By framing self-care as a social practice, this research underscores the need for systemic, contextually sensitive interventions that integrate material provision, skill development, and stigma reduction. SPT offers a robust framework for designing multi-level strategies to enhance self-care for leprosy and other chronic conditions, promoting sustainable health outcomes in marginalised communities.
