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WHO_Leprosy_Module2_EN

This training module for health workers focuses on recognizing and referring cases of leprosy, detailing symptoms, signs, and examination steps. Key indicators for suspicion include skin patches, loss of sensation, and deformities, while non-leprosy conditions are also outlined. Health workers are instructed to document patient details and refer suspected cases for diagnosis and treatment.

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Seifudin Usman
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
3 views

WHO_Leprosy_Module2_EN

This training module for health workers focuses on recognizing and referring cases of leprosy, detailing symptoms, signs, and examination steps. Key indicators for suspicion include skin patches, loss of sensation, and deformities, while non-leprosy conditions are also outlined. Health workers are instructed to document patient details and refer suspected cases for diagnosis and treatment.

Uploaded by

Seifudin Usman
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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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.

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