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.
Objectives The study aimed to understand the journey of patients with reactional episodes of leprosy treated at a specialised outpatient clinic in the state of Mato Grosso, considered the most endemic state in the country. Methods Qualitative, descriptive, and exploratory study with 11 individuals who experienced reactional episodes. Data collection was carried out through audio-recorded interviews, guided by a semi-structured interview instrument, and the data were analysed using content analysis. Results The reports showed long journeys in time and space, marked by errors and delays in the diagnosis of both leprosy and its reactional episodes, reflecting the difficulty of health professionals in recognising the disease early. Conclusion Stigma and prejudice were factors that triggered complications and negative feelings about the patient and his life. The weaknesses in the healthcare network demonstrate the need to strengthen primary care, improve control actions, and establish effective care flows for these patients, preventing complications such as disabilities and physical deformities. Ongoing training of health professionals is essential to guarantee comprehensive care, as well as promoting early diagnosis, health education, autonomy, and emotional support for patients and their families.
Leprosy shows a clinicopathological spectrum that reflects divergent host responses to Mycobacterium leprae, with macrophages playing a central role in lesion immunopathology. This systematic review synthesised in situ evidence on marker-defined macrophage phenotypes in human leprosy skin lesions. A PRISMAguided search identified 14 observational studies published between 1996 and 2023 that examined macrophage-associated markers in clinically classified skin biopsies using immunohistochemistry or lesion-based molecular approaches. Because the included studies were heterogeneous in marker panels, lesion classification, laboratory methods, and outcome reporting, findings were synthesised narratively rather than by meta-analysis. Tuberculoid-spectrum lesions were consistently associated with M1-related marker patterns, including NOS2 (iNOS), TNF-alpha, IL-6, and MMP-9, in keeping with preserved granuloma organisation and bacillary containment. Lepromatous lesions more often showed dominant M2-associated and M4-like marker-defined phenotypes, characterised by IL-10, CD163, ARG1, PPARG, STAT6, IDO, MRP8, and MMP7, consistent with immuno-regulatory, tissue-remodelling, and bacillus-permissive lesion environments. These findings improve lesion-level biological interpretation across the leprosy spectrum, but they do not yet support routine diagnostic, prognostic, or reaction-prediction use. Macrophage phenotypic reprogramming remains a hypothesis-generating translational direction requiring longitudinal valida-tion.
Background Leprosy control depends on timely case detection and uninterrupted multidrug therapy (MDT) to prevent disability and interrupt transmission. Armed conflict disrupts health systems and may severely affect surveillance and treatment of neglected tropical diseases. The impact of the Tigray conflict (Ethiopia) on leprosy services has not been systematically assessed. This study examines how armed conflict affected leprosy detection, disability, and treatment outcomes in Tigray, Ethiopia. Methods A retrospective longitudinal analysis of routine leprosy surveillance data from the Tigray Region was conducted for the period 2016-2025. Study years were categorised into pre-war (2016-2020), war (2021-2023), and post-war (2024-2025) phases. Outcomes included number of newly detected cases, notification rates, proportion of new cases with Grade II disability at diagnosis, and treatment completion. Descriptive comparisons were made across conflict phases using Stata version 17. Results A total of 180 new leprosy cases were reported during the study period. During the pre-war phase, case detection and treatment completion were stable. No leprosy cases were reported during the war period, reflecting the collapse of surveillance and service delivery. In the post-war phase, detection partially recovered with 13 cases in 2024 and 33 in 2025. In 2024, all detected cases presented with Grade II disability (13/13), declining to 3.4 degrees'c (1/33) in 2025. Treatment completion decreased to 69.2 degrees'c in 2024, compared with 93.2 degrees Jc-100 degrees Jc during the pre-war period but returned to 100 degrees Jc in 2025. Conclusions Armed conflict in Tigray was associated with interruption of leprosy detection and care, followed by increased disability due to delayed diagnosis. Strengthening surveillance resilience, active case-finding, and post-conflict rehabilitation services are essential to mitigate the long-term impact of conflict on leprosy control.
