1. Salcido, Richard "Sal MD"

Article Content

Despite advancements in care, leprosy continues to be a health issue. Interestingly for the wound care specialist, it is a leading cause of nonhealing neuropathic wounds around the world.


Leprosy is rare in the United States. However, because of immigration patterns, we may see patients with wounds who have moved to the United States from countries in which leprosy is endemic. In some cases, then, leprosy should be a part of the differential diagnosis of nonhealing neuropathic wounds.


This editorial examines where leprosy is endemic and what can be learned from the pioneers in leprosy care.


By the Numbers

Worldwide, 640,000 new cases of leprosy were identified in 1999, growing to 738,284 in 2000 and 763,917 in 2002. Only 133 new cases were found in the United States in 2002. According to the World Health Organization, as of 2002, 90% of all leprosy cases occurred in Brazil, Madagascar, Mozambique, Tanzania, and Nepal.


Between 1 and 2 million people worldwide are permanently disabled as a result of leprosy. Individuals receiving antibiotic treatment or having completed treatment are considered free of active infection.


Caused by a slow-growing bacillus, Mycobacterium leprae, leprosy typically attacks the "cool"areas of the body, including the nasal mucosa, hands, feet, and the distal peripheral nerves. Leprosy is associated with symmetric skin lesions, nodules, plaques, and a thickened dermis.


Pioneering Work

Leprosy has been described in various forms since antiquity. In more recent times, the term leprosy has been associated with the individuals who pioneered the diagnosis and treatment of the disease and advanced our knowledge of caring for these chronic wound patients.


Leprosy was given the eponym Hansen's disease after Gerhard Henrick Armauer Hansen (1841-1912). A Norwegian physician, Hansen is remembered for identifying M leprae as the causative agent of leprosy in 1873.


Joseph de Veuster (1840-1889), who took the name Father Damien when he was ordained as a priest, was working as a missionary in the Hawaiian islands when he volunteered to work among the lepers who had been relocated by the Hawaiian government to an isolated site on the island of Molokai. He later became infected and eventually died from the disease. Father Damien is credited with treating not only the physical aspects of the disease, but also the whole person.


Paul Wilson Brand, CBE, MB, FRCS (1914-2003) was a renowned hand surgeon and leprosy specialist. His research led to our understanding that the ulceration and paralysis seen in patients late in the course of leprosy is caused by anesthesia and nerve damage.


In 1966, Dr Brand and his wife, Margaret (also a physician), began working at the National Leprosarium in Carville, LA, at the invitation of the United States Public Health Service. For more than 20 years, Dr Paul Brand studied the biomechanics of the hand, the use of total contact casting to heal plantar ulcers in the neuropathic foot, and how thermal mapping could be utilized to manage insensate feet and residual limbs. In fact, we owe much of what we know about managing neuropathic foot ulcerations related to diabetes to Dr Brand's pioneering work.


At the Borders

As I mentioned earlier, leprosy is not common in the United States. It occurs primarily in the border regions of this country, and most diagnosed cases are linked to immigrants. The US Department of Health and Human Services continues to maintain Hansen's disease outpatient clinics in several states, including Florida, Texas, Louisiana, California, and New York.


Leprosy is, admittedly, an unusual cause of nonhealing wounds. The wound care specialist should, however, consider leprosy as a factor in patients who are from endemic areas of the United States, South America, and abroad.


Selected References


Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Mycobacterial and Mycotic Diseases. Hansen's Disease (leprosy). Available online at; accessed May 4, 2004.


HealthServe. Obituary: Dr Paul Wilson Brand, CBE, MB, FRCS (Eng) 1914-2003. Available online at; accessed May 4, 2004.


US Department of Health and Human Services, Bureau of Primary Health Care. The National Hansen's Disease Programs. Available online at; accessed May 4, 2004.


World Health Organization. Leprosy Fact Sheet No. 101; revised January 2003. Available online at; accessed May 4, 2004.