Leprosy mainly affects the skin and the peripherical nervous system.

The early stage of Leprosy, the Lepra indeterminata (LI) only shows a discreet and harmless symptomatology. This can manifest itself as a mark, seldom two marks, with an unclear edge, on darker skin hypopigmented and on lighter skin in erythematous form. The dysfunction of sensibility and anhydrous are caracteristical.
This early form can stay undetermined, heal spontaneously or develop into the tuberculoid, lepromatous or Borderline-Leprosy
.

 

The tuberculoid form of Leprosy (TT) shows asymmetrical changes of the skin with clear edges. The surface is higher and rough, hypopigmented or erythematous, often healing tendency starts in the centre. Within the skin transformation, hair loss, anhydrose and clear dysfunction of sensibility are the case. As well as skin transformation - also with patients who do not suffer from these transformations - the peripheral nerves can affected. In this case, they are swollen and knots can be felt. Nerves are affected asymmetrically.

 

A change of the N Ulnaris leads to a claw like paresis of the fourth and fifth finger. Changes of the N medianus cause paresis of the thumb, the index finger and the middle finger. It is more seldom that the N radialis is damaged. In this case, there is a deformity in form of drop hand.
If the lower extremities, the N peronaeus,  are affected, this leads to a drop foot., in case of a deformed   N tibialis we speak of claw toes.

 

If  the N facialis is affected, closure of the eyelids is impaired (Lagophtamus) and eventually leads to blindness.

 

All these nerves are located directly underneath the skin. They are often damaged since the bacteria multiply in cooler parts of the human body.
The damage of motor nerves leads to a muscle weakness, muscular artrophy and paresis.
A damage of sensible and vegetative nerves also causes anaesthesia and dryness of the skin.
Loss of sensibility is the cause of secondary changes which lead to mutilation.

 

Verstümmelung
Mutilation of the hands
Verstümmelung der Finger
Mutilation of fingers

 

 

Borderline Leprosy (BB)

 

Depending on the immunity of the body the symptomatology of leprosy can develop two different forms: TT or LL form.

The BT form is similar to the TT form,.
The  BB und BL forms however lead to LL form of Leprosy.

 

Lepromatous Leprosy (LL)

 

This is the worst form of the disease. It is also the infectious form of Leprosy.

 

Lepromatöse Form, Flecken
Lepromatous Leprosy
Lepromatöse Form, Leprome
Lepromatous Leprosy

 

 

There are multiple marks that develop into papules and knots.

 

Lepromatöse Form, Leprome
Multibacillary (MB) Leprosy
Lepromatöse Form, Leprome
Multibacillary (MB) Leprosy

 

 

The ‘Lion Face’ is typical of Multibacillary changes on the face. Madarosis:  loss of hair, eye lashes and eye brows.