Leprosy physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Physical examination will depend on the class of leprosy in each patient and may include findings such as hypopigmented skin lesions, usually macular or papular, thickened dermis, loss of sensation or peripheral nerve thickening, with common evolvement of the nasal mucosa.

Physical Examination

Leprosy may have different presentations, depending on the immune response of the host. The disease often affects the skin, nerves, and mucous membranes in different patterns and with different intensities. The possible physical findings of the disease include:

Appearance of the Patient

• Fatigue is often present
• Weight loss is often present
• Anhidrosis may be present

Vitals

• Fever may be present

Skin

• Painless cuts, wounds and burns are often present, predominantly on the hands, arms, legs and feet
• In tuberculoid or paucibacillar leprosy, larger hypopigmented or erythematous macules are often present
• In borderline tuberculoid or paucibacillar leprosy, macules are often sharply defined with a central clearing, more numerous than the in previous category and generally located unilaterally.
• In mid-borderline andlepromatous or multibacillar leprosy, central area of the lesions is often anesthetic
• In borderline lepromatous leprosy, lesions are often erythematous macules and/or papules, symmetrically distributed throughout the body. Nodular lesions are often present and there may be areas of normal skin between the lesions, however, the margins of the lesions are diffuse, instead of well-defined.
• In lepromatous leprosy, lesions are often generalized throughout the body and may be of macular, papular or nodular origin. There is often loss of body hair, particularly of the eyebrows and eyelashes
• In indeterminate leprosy, lesions are often hypopigmented or erythematous macules with diminished sensation

Head

• Facial paralysis may be present
• Lack of eyebrows and eyelashes may be present
• Lumps are often present, predominantly on the face

Eyes

• Lagophthalmos is often present
• Dry corneas are often present
• Corneal abrasion is often present
• Corneal ulceration is often present
• Blindness may be present

Ears

• Nodular thickening of the earlobes may be present

Nose

• Saddle nose may be present, particularly in lepromatous leprosy
• Perforated nasal septum may be present
• Invasion of the nasal mucosa may be present, particularly in lepromatous leprosy, leaden to nasal stuffiness
• Epistaxis may be present

Extremities

• Weakness of the hands and feet may be present
• Claw fingers are often present
• Foot drop is often present
• Edema of the hands and feet may be present
• Fractures may be present

Neurologic

• Sensory and/or motor loss are often present, predominantly in skin lesions and on the territories located after enlarged peripheral nerves:

• In tuberculoid leprosy this often occurs in the vicinity of the skin lesion
• In lepromatous leprosy this loss is often more generalized

• Paresthesias are often present, predominantly in the hands and feet
• Tender and/or enlarged peripheral nerves are often present
• Painful neuropathy may be present

Gallery

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  Enlargement of the great auricular nerve following attack by Mycobacterium leprae.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
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  Inflammatory cutaneous lesion on the thorax classifies as tuberculoid, paucibacillary form of leprosy.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Nodular lepromatous or multibacillary leprosy. Presence of cutaneous nodules and missing eyebrows.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Pathologic changes associated with lepromatous or multibacillary leprosy. Note active ulcerative lesion on the plantar surface of left toe.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
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  Pathologic characteristics associated with a case of lepromatous or multibacillary leprosy. Note absence of eyebrows.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
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  Borderline, or dimorphous leprosy with bilateral involvement of the buccinator muscles, as well as dermatomyositis.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
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  Tuberculoid or paucibacillary leprosy lesion with hypopigmented cutaneous plaque lateral to right nipple. Note elevated scaly borders.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
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  Complications of lepromatous or multibacillary leprosy. Note saddle-nose deformity following disintegration of nasal cartilage and lack of eyebrows.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention
• 
  Cutaneous changes of lepromatous leprosy. Note reddish-brown nodules atop the left ala.Adapted from Public Health Image Library (PHIL), Centers for Disease Control and PreventionPublic Health Image Library (PHIL), Centers for Disease Control and Prevention

References

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