Leprosy starts by damaging the small nerves in the skin’s surface. The first outward sign is usually discoloured patches where there is no feeling. If treated at this early stage, damage or disability is unlikely.
If left untreated, leprosy goes on to damage the large nerves in the elbow, wrist, knee and ankle. The resulting damage can lead to loss of sensation in the hands and feet and muscle paralysis, which causes clawed fingers and foot drop. Loss of sensation in the hands and feet means everyday activities are fraught with danger – burns go unrecognised and stones in shoes unnoticed leading to ulcers developing. These can be difficult to heal and become infected, often leading to the shortening of fingers and toes or ultimately, amputation of limbs.
Leprosy can damage nerves in the face causing the eyelid muscles to stop working. The eyes are no longer protected by the blinking mechanism and can become easily damaged, which eventually leads to blindness. Leprosy can also damage the bones of the nose causing it to collapse and flatten, a common facial trait witnessed in people affected by leprosy.
An effective cure for leprosy has been available since 1982 in the form of multidrug therapy – a combination of three drugs taken daily for six to 12 months. But while treatment halts the progression of this cruel disease, it cannot turn the clock back in terms of disability. A clawed hand or foot drop can be restored with surgery. Surgery, however, cannot restore the feeling to hands and feet meaning they can become easily injured. Protective footwear can be worn to reduce the chances of injury and of ulcers developing. The blinking mechanism can also be restored to the eye by surgery. But once eyesight has been lost as a result of injury to the eye, nothing can be done to reverse the situation.
According to the latest World Health Organisation statistics, there were 213,899 new cases of leprosy diagnosed globally in 2014 – around one every two minutes. More than half of these new diagnoses were in India. Due to the reluctance of leprosy patients to seek treatment because of the stigma surrounding the disease, The Leprosy Mission England and Wales regards these figures as understated.