Can Leprosy Be Cured?

Spinalonga, a small island in Greece, is said to have been used by the Greek government as a quarantine site for leprosy patients between 1913 and 1957.

During this period, leprosy sufferers faced negative stigmas and were mistreated, even by their own families. The physical disabilities caused by the disease led to prejudice, fear, and segregation across all social classes, forcing the affected individuals into a life of poverty and loneliness.

To this day, Indonesia has not been declared leprosy-free. Stigma and discrimination against leprosy patients and their families make it challenging to eliminate leprosy from society. According to the Ministry of Health, in 2022, Indonesia ranked third in the world for leprosy cases, following India and Brazil.

Symptoms

Leprosy affects nerves, skin, eyes, and the mucosa lining of the nose. Early symptoms include white spots (hypopigmentation) or redness on the skin and lesions shaped like lumps. These symptoms may persist for weeks and are usually accompanied by numbness and muscle weakness in the infected area.

The disease progresses slowly, and symptoms may take 20–30 years to appear after the bacteria have multiplied in the body. Common symptoms include:

• Skin wounds or lesions that do not heal for months (flat or slightly raised, light or slightly reddish).
• No pain when having a wound.
• Lumps on the skin.
• Numbness in the skin, resulting in an inability to feel differences in temperature, pressure, or touch.
• Muscle weakness.
• Lack of sweating in the skin.
• Dry eyes and infrequent blinking.

Transmission

Leprosy, or Hansen's disease, is a chronic condition caused by Mycobacterium leprae. This disease causes severe skin lesions that can lead to nerve damage in the hands, feet, and skin throughout the body.

The bacteria responsible for leprosy were discovered by Dr. Gerhard Armauer Hansen, a Norwegian doctor, in 1874. He was researching unknown bacteria in the skin nodules of leprosy patients. Hence, leprosy is often referred to as "Hansen's disease."

Leprosy is transmitted through droplets from the nose or mouth of an infected person, inhaled during close contact. Prolonged close contact with untreated leprosy patients also increases the risk of transmission. Therefore, those living in the same household as a leprosy patient have the highest risk of contracting the disease.

However, leprosy is not transmitted through handshakes, hugs, sharing meals, or sexual contact. Pregnant women with leprosy do not transmit the disease to their unborn children.

After several weeks of treatment with MDT (multidrug therapy), leprosy transmission has been significantly reduced, if not eliminated.

Types of Leprosy

Leprosy is divided into several types based on symptoms and the body's immune response: 

1. Tuberculoid leprosy: The mildest type, characterized by one or a few flat, pale skin patches. The infected skin area may feel numb due to nerve damage below. This type is less contagious than other types.

2. Lepromatous leprosy: A more severe than tuberculoid leprosy, marked by nodules and widespread skin rashes on the face, ears, wrists, elbows, knees, and buttocks.
Patients may experience numbness and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. This type is more contagious than tuberculoid leprosy.

3. Borderline leprosy: A combination of tuberculoid and lepromatous leprosy. It is also called dimorphous leprosy.

The World Health Organization (WHO) divides the types of leprosy into two types based on bacterial load:

1. Paucibacillary (PB): Characterized by 1-5 skin patches on the body, tends to be dry and not as contagious as in the MB type, and the sensation of numbness is felt.
The number of Mycobacterium leprae bacteria in the sufferer's body is very small. Usually, only a few or even no bacteria are found in the sample.

2. Multibacillary (MB): Involves more than 5 skin patches on the body, with a wider distribution and a less clear sensation of numbness. The number of bacteria in the sufferer's body is very large.
Many Mycobacterium leprae bacteria are found in laboratory tests, such as in skin or nerve examinations.

Treatment

In the past, leprosy patients were isolated, but now leprosy is treatable.

Early diagnosis and complete treatment are essential to prevent the spread of the disease. Leprosy patients must adhere to daily treatment with a multidrug regimen (MDT) for 6–18 months.

The World Health Organization's 2018 guidelines for leprosy diagnosis, treatment, and prevention recommend the same three drugs—rifampicin, dapsone, and clofazimine—for all leprosy patients. The type, dosage, and treatment duration depend on the leprosy type.

Incomplete leprosy treatment can lead to various complications. When it affects peripheral nerves, leprosy can cause nerve weakness and numbness, making patients unable to feel pain or discomfort.

Leprosy can also attack facial nerve areas, particularly the nose and eyes. Nerve damage in the nasal area can lead to drying and numbness of the mucous membrane, causing nasal congestion and chronic nosebleeds.

Secondary nose infections can result in nasal cartilage erosion, leading to an abnormal nose shape. In severe cases, leprosy affecting the eyes can cause glaucoma and blindness.

In men, leprosy can cause erectile dysfunction and infertility. In more severe cases, leprosy can affect the kidneys, leading to kidney failure.

Untreated leprosy can cause permanent damage to the skin, nerves, arms, legs, feet, and eyes.

Leprosy has existed for centuries. If you experience symptoms such as skin wounds, numbness, or muscle weakness, do not ignore them. Remember, with regular and consistent treatment, leprosy can be cured.