Changing Scenario of Hansen's Disease

Despite significant improvements in leprosy treatment and outlook for patients since the introduction of multidrug therapy (MDT) 3 decades ago, the global incidence remains high and patients often have long-term complications associated with the disease. There is much evidence that incidence of the disease has declined in many populations. Not only did leprosy disappear from northern Europe over recent centuries, but there is also evidence that transmission of M. leprae has recently stopped in several populations (e.g. Japan, South Korea) which were endemic throughout most of the 20th century. In several other countries the new case detection statistics show no convincing decline in recent years, though the actual underlying trends are unclear. India has accounted for about 60% of the world’s leprosy cases for the last 20 years. Brazil has the second highest number of cases and Indonesia the third. This initial clinical presentation is known as indeterminate leprosy and is observed as the first sign of the disease in about 20–80% of the patients. In the experiences of Kumar B, Uprety S, and Dogra S. the three out of four indeterminate cases of leprosy heal on their own and the rest become ‘determinate’ and enter the clinical spectrum of leprosy. There are no studies regarding Indeterminate leprosy persisting unchanged neither regressing spontaneously nor changing to one of the definitive forms in the leprosy spectrum. Progressive Indeterminate Leprosy is defined as those cases of Indeterminate leprosy remaining clinically as well as histopathologically Indeterminate, progresses to cause one or more of deformities, disabilities, trophic ulcers, osteomyelitis and foot drop without becoming determinate leprosy.