Neglected Tropical Diseases
Leprosy
Training for health workers
on skin NTDs
Module 2: Leprosy – Suspect and Refer
Learning Objectives
By the end of this module, you should be able to:
• know when to suspect leprosy
• differentiate between leprosy and non-leprosy
skin patches
• know the action to be taken when a person
presents with lesions suggestive of leprosy
Content
1. Symptoms and Signs to Suspect Leprosy
2. Features of the skin that are not indicative of leprosy
3. Steps to examine a person to suspect leprosy
1. Symptoms and Signs to Suspect Leprosy
Leprosy should be suspected in people with any of the following
symptoms or signs:
1. Hypo-pigmented (pale) or erythematous (reddish) patches on the
skin (the most common sign of leprosy)
2. Loss, or decrease, of sensation to temperature, touch or pain in the
skin patch
Symptoms and Signs to Suspect Leprosy
(continued)
3. Shiny or oily or smooth appearance of the skin (infiltration)
4. Nodules on a shiny, erythematous skin
Infiltration of skin of ear lobe Nodules on ear lobes
Symptoms and Signs to Suspect Leprosy
(continued)
5. Numbness or tingling of the hands or feet
6. Weakness of the hands, feet or eyelids
7. Presence of deformity in hands or feet or eyes
Inability to close
eye lid
Deformities of hand
Symptoms and Signs to Suspect Leprosy
(continued)
8. Loss of sweating in an area of skin
9. Painful or tender nerves
10. Painless wounds or burns on the hands or feet.
2. Features of the skin that are not indicative of
leprosy
Skin patches that are
• Present from birth (i.e. birth marks)
• With normal sensation (e.g. Pityriasis rosea)
• Itchy (e.g. Fungal infections of skin)
• Depigmented (e.g. Vitiligo)
• Hyper-pigmented (Black in colour, e.g. post inflammatory
hyper-pigmentation)
• With scaling of skin (e.g. Psoriasis)
Features of the skin that are not indicative of
leprosy (continued)
Birth Mark: A hypopigmented patch, no loss of
sensation, present since childhood
Vitiligo: Depigmented patches,
no loss of sensation
Features of the skin that are not indicative of
leprosy (continued)
Fungal infection: Expanding patch on the
abdomen, itchy
Pityriasis rosea: Multiple hypopigmented
patches, itchy and self-limiting (disappears
within 3 to 4 weeks)
3. Steps to examine a person to suspect
leprosy
1. Discuss with the person
2. Examine the skin
3. Test the skin patches for sensation
4. Palpate the peripheral nerves
5. Examine hands, feet and eyes for nerve damage
6. Refer for Diagnosis
Steps to examine a person to suspect leprosy
(continued)
1. Discuss with the person
i. How long has the skin patch been
there? How did it start? Has it
changed?
ii. Are the patches itch or painful?
Steps to examine a person to suspect leprosy
(continued)
1. Discuss with the person
iii. Does the person have unusual
sensations in their hands or feet, such
as numbness, tingling or a burning
feeling?
iv. Does the person think that their
hands or feet have become weaker?
v. Does the person have problems with
holding or lifting things and with
moving their hands and feet?
Steps to examine a person to suspect leprosy
(continued)
1. Discuss with the person
iii. Does the person have
visible deformities in the eyes,
hands and feet?
iv. Does anyone in the family or
extended family suffer from
similar disease with skin
patches?
v. Has the person experienced
any social problems?
Steps to examine a person to suspect leprosy
(continued)
2. Examine the skin
A female health worker should examine a female person or in the
presence of a women.
Explain the procedure of examination and take the consent of the person
Examine the skin from head to toe, and on the front of the body as well as
the back.
Leprosy patches are lighter than the surrounding skin (hypopigmented);
they may be reddish in colour.
Patches can be found in many shapes.
Steps to examine a person to suspect leprosy
(continued)
3. Test the patches for sensation
Ask the person to Lightly touch the Ask the person to
close their eyes skin patch with point to the place
cotton wool/ball where it is touched.
point pen
If the person cannot feel the touch of cotton wool/ball point
when it is touched on the patches, he or she may have
leprosy.
Steps to examine a person to suspect leprosy
(continued)
4. Feel the nerves
Enlarged nerves can be a sign of leprosy
Commonly enlarged nerves are the ulnar and the common peroneal
(lateral popliteal) nerves
Ulnar nerve – back of the elbow Common Peroneal (Lateral
popliteal) nerve – below the knee
Steps to examine a person to suspect leprosy
(continued)
5. Examine Hands and Feet for dryness
• Nerve damage can lead to loss of feeling in the
hands and feet.
- Testing sensory loss in hands
- Testing sensory loss in feet
Steps to examine a person to suspect leprosy
(continued)
6. Refer for diagnosis
Health workers should refer the person to nearest or
designated health care centres if the health worker suspects
leprosy for confirmation of diagnosis.
Process of Referral
Step 1 Step 2 Step 3
Record person’s Follow-up
Discuss to know
the details including name,
address and phone outcome
condition
number and reason for
referral
Recap
i. Refer all suspect cases to the nearest or designated
health centre for diagnosis and treatment.
ii. Document patient details - name, father’s or spouse’s
name, address and phone number of patient.
