Leprosy still occurs in the United States: Are you at risk?

man-holding-armadillo.jpg
Man holding an armadillo: U.S. dermatologists are finding that some patients who get leprosy have either handled an armadillo or spent time outdoors in an area where these animals live.

In recent years, a few people in the United States have been diagnosed with leprosy, a disease that many believe no longer exists. While the very word “leprosy” evokes fear in persons around the world, there’s no need to panic.

In the United States, leprosy is no longer an uncontrollable disease. It can be cured. With treatment, you can prevent problems, such as the loss of feeling or blindness. These problems can only develop when someone has leprosy for a long time. Today, we also know how to reduce the risk of catching it.

How do people get leprosy?

Leprosy, also called Hansen’s disease, is a contagious disease. One way it spreads is from person to person. Even so, it’s actually hard to catch. According to the Centers for Disease Control and Prevention (CDC), about 95% of humans are immune to the bacteria that cause this disease1.

Because so many people are immune, how we catch it is still a bit of a mystery.

Scientists have learned that to catch leprosy, a healthy person must have months of close contact with someone who has leprosy. It’s believed that the disease spreads when a person who has leprosy coughs or sneezes. When a healthy person repeatedly breathes in the infected droplets, this may spread the disease.

It takes a lot of exposure to catch leprosy. If someone has leprosy, a single handshake or few hours spent sitting next to that person won’t spread the disease. You’d have to shake hands or sit next to that person often to get leprosy.

You can also get leprosy from an armadillo. It’s possible to catch the disease by handling an armadillo or spending time in an area where these animals live.

Who gets leprosy in the United States?

U.S. dermatologists have noticed that their patients with leprosy have one of these risk factors:

  • Lived in a country where leprosy is more common, such as India, Brazil, China, Indonesia, or parts of Africa
  • Handled an armadillo
  • Spent time outdoors in an area where armadillos live

If you have any of these risk factors, it doesn’t mean that you will get leprosy.

What are the signs and symptoms of leprosy?

The bacteria that cause leprosy reproduce very slowly. You may notice the first signs in 3 to 4 years — but it can take 20 years or longer for signs to appear.

Since it takes so long to see signs, it can be difficult to know what’s causing early signs and symptoms, which include the following:

  • Rash (or spots) that looks red or pink
  • Swelling under your skin
  • Patch of skin that looks lighter (or darker) and may be dry or flaky
  • Loss of feeling where you have a rash or patch
  • Numbness in a finger or toe
  • Eyes become extremely sensitive to light

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Early signs of leprosy caught by dermatologists: Leprosy often begins with a rash, and the skin beneath the rash may be numb.

Without treatment, the bacteria that cause leprosy can continue to reproduce. In time, they can damage nerves and other parts of your body. If this happens, you may notice one or more of the following:

  • Numbness in your hands or feet
  • Fingers and thumbs curl, leaving you unable to straighten them
  • Eye problems, such as difficulty blinking, which may lead to dry eyes, eye sores, and eventually blindness
  • Loss of a finger or toe

How is leprosy cured?

Antibiotics can cure leprosy. They work by killing the bacteria that cause leprosy.

While antibiotics can kill the bacteria, they cannot reverse damage caused by the bacteria. If you already have a disability, such as loss of feeling or blindness, that’s permanent. Antibiotics cannot reverse the damage done to the body.

How do doctors find leprosy?

If it looks like you may have leprosy, a board-certified dermatologist will ask questions to find out if you have any risk factors. Be sure to tell your dermatologist if you have lived in another country or spent time around armadillos.

Your dermatologist will also examine your skin. Because leprosy can look like many other conditions, your dermatologist may remove a bit of the afflicted skin or the fluid beneath it. This will be examined under a microscope. If the bacteria that cause leprosy are found, the diagnosis is leprosy.

Can leprosy be prevented?

You can reduce your risk. Dermatologists recommend the following:

  1. Never handle an armadillo. Some armadillos carry the bacteria that cause leprosy.

  2. Stay out of places where you find armadillos. One patient who developed leprosy had been clearing overgrown wild land where armadillos had been found for more than 20 years. Another woman gardened in her backyard, where several armadillos lived.

  3. If you notice any change to your skin, see a board-certified dermatologist. The earlier any disease is found, the better.

If you notice a change to your skin, don’t panic. Leprosy is no longer something to fear. Today, the disease is rare. It’s also treatable. Most people lead a normal life during and after treatment.


Images
Images used with permission of Journal of the American Academy of Dermatology:

1J Am Acad Dermatol. 2006 Oct;55(4):714-6
2 J Am Acad Dermatol. 2017 Feb 3;3(1):58-60
3 JAAD Case Rep. 2016 May; 2(3): 189–92
4 J Am Acad Dermatol. 2014 Oct;71(4):795-803

References
Centers for Disease Control and Prevention. “Hansen’s Disease (Leprosy).” Page last reviewed February 10, 2017. Last accessed May 23, 2018.

Domozych R, Kim E, et al. “Increasing incidence of leprosy and transmission from armadillos in Central Florida: A case series.” JAAD Case Rep. 2016 May; 2(3): 189–92.

Rea TH and Modlin RL. “Leprosy.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1786-96.

Rendini T and Levis W. “Autochthonous leprosy in the eastern United States is from international migration, not from armadillos.” JAAD Case Rep. 2017 Jul; 3(4): 370.

Truman RW, Singh P, et al. “Probable zoonotic leprosy in the southern United States.” N Engl J Med. 2011 Apr; 364:1626-33.

1 Centers for Disease Control and Prevention (CDC). “Hansen’s disease (leprosy): Transmission.” Page last updated February 10, 2017.