A New Atlas of Leprosy by A. Colin McDougall, Yo Yuasa

By A. Colin McDougall, Yo Yuasa

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The picture opposite (left) shows the planter (under) surface of a patient’s foot with ulceration at the base of the big toe, on one of the main pressure points in walking. There is also deformity and some ‘clawing’ of the toes. He presented late with established damage to the peripheral nerve supplying sensation and muscle power to the foot. EARLY DIAGNOSIS and treatment with MDT would have PREVENTED this situation. DISABILITY–DEFORMITY 3. Face and eyes. Upper picture; active MB leprosy showing thickened (infiltrated) and shiny skin on the face.

NON-LEPROSY CONDITIONS OF THE SKIN – Simple commonly occurring conditions 11. Vitiligo. e. complete loss of colour) as opposed to the much more typical hypopigmentation (reduction of pigment) seen in leprosy. However in the early stage of this disfiguring disease, incomplete loss of pigment may lead to confusion with leprosy. Sensation, sweating and skin texture are normal. 57 58 NON-LEPROSY CONDITIONS OF THE SKIN – Simple commonly occurring conditions 12. Pityriasis rosea. Occurs typically in adolescents or young adults.

A reaction developed suddenly after the start of multidrug therapy (MDT). The previous lesion became swollen, painful and tender. The picture is an important reminder of the importance of nerve involvement in Type 1 reactions. The great auricular shown here happens to have limited clinical significance, but if peripheral nerves in the limbs, or those supplying the eye region are involved, loss of sensation and/or muscle power may occur, sometimes very rapidly. Consult your supervisor or national guidelines on the use of analgesics, splinting or steroids (prednisolone), according to the severity of the reaction.

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