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U.S. Department of Health and Human Services
Health Resources and Services Administration
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Hansen's Disease Cardinal Signs & Symptoms

Delayed diagnosis of Hansen's disease (leprosy) can have serious neurological consequences. The typical skin lesions and classic neuropathy of leprosy are readily recognized in countries where the disease is more common, but in the U.S., where leprosy is rare, it can be difficult to diagnose. Physician awareness is key to the early diagnosis and treatment that can prevent disability.

Consider the diagnosis of leprosy when ...

Patient presents with non-responsive skin lesion and is

  • Immigrant from country with high incidence of leprosy
  • U.S. resident with history of foreign travel
  • Resident of Texas or Louisiana
  • Has referral history of multiple physician/specialist and/or frequent emergency room visits

Cardinal Signs

  • Localized skin lesions
    • Raised or flat
    • Light or pigmented
    • Sensory loss in lesion
  • Thickened peripheral nerves
  • Demonstrated acid-fact bacilli in lesion

Laboratory Tests

  • There are no serological or skin tests
  • Skin biopsy needed for definitive diagnosis
  • PCR for M. leprae DNA may be needed in special circumstances

Patients with Delayed Diagnosis

Because of a delay in diagnosis, patients may present for diagnosis of Hansen's disease who are already undergoing a Reversal or ENL reaction:

  • Acute, immunological complications may confuse clinical picture
  • Acute inflammation of lesions
  • Neuritis
  • Arthritis
  • Edema, loss of sensation and weakness in the hands or feet
  • Such patients often have seen other specialists before dermatologist referral

Seek prompt consultation with National Hansen's Disease Program. Phone 1-800-642-2477, weekdays 9 AM to 5:30 PM ET (in Hawaii: 1-808-733-9831).