 There was a time when this disease was considered highly infectious and devastating. Now, with the advances in the treatment and people coming forward to get this disease diagnosed and treated, the prevalence of the disease has come down. I am Dr. Simantini Sakarnandi from Manipal Hospital Goa, the consultant dermatologist. Today, I will be talking about Hansel's disease also known as leprosy. So, leprosy is a chronic infectious disease. It is caused by a bacteria known as mycobacterium lepre. So, this disease involves skin, nerves and it can also involve certain other organs. So, leprosy usually spreads by respiratory contact. That is, when a person sneezes or coughs, the droplets which go out in the air and if you are in the same room, like you suppose in the same close contact, then you can get leprosy. Now, this is possible only in a case of leprometous leprosy. That is, when your bacteria load in the body is very, very high. The second mode of transmission of leprosy is through skin lesions. That is, if the patients have huge ulcers, which is again in a patient who has very high bacillary load, very high bacteria count in their body, then they can transmit leprosy. When a person comes in contact with the leprosy bacilli, whether a person will get leprosy or not is determined by their patient's immune response. So, if you have a very good immune response, you can locate, you can localize that bacilli and people can have few skin lesions. So, that is what we call posibacillary leprosy. That is, when you have fewer skin lesions, less than five patches in the body. But, if your immune system is bad and if you get something where the bacillary load increases in your body, your body is not able to fight the bacteria, then the bacteria can multiply easily and you get something called as multi-bacillary leprosy. There is more than five lesions. So, when I say skin lesions, means the commonest signs which patients come to us is with the skin patches. Now, these patches are like, you know, hypopigmented, like, you know, less color. I would not say white patches, but they are lighter than the skin color. They would be dry and the first symptom that you usually get is you are not able to feel any sensations on those patches, okay? So, for example, the temperature sensation gets lost. They are not able to appreciate hot and cold. The second would be the nerves, okay? So, the nerves get involved. In the nerve symptoms, the first thing what you will feel is tingling and numbness, like, and scrolling sensation. You are able to also get some amount of motor weakness. Like, you lose gripping power, or chappals falling off the feet. So, these are first some of the commonest symptoms. Very rarely, patients come with the multi-bacillary leprosy, where there are multiple patches on the body. There could be nodules, like, you know, raised skin lesions. Or they can also come with redness, involvement of ear lobes. So, these are the signs of multi-bacillary leprosy. If the symptoms of leprosy are ignored, like, suppose a patient comes with very few patches. Now, if your body's immunity is good, the body is able to contain the bacteria to those areas, then you may have those patches for many years. So, it's not like if you come in contact with a leprosy patient today, or if you have a leprosy basilar in your body today, you will manifest the symptoms tomorrow. It can take years or months also to develop the symptoms. But if a patient has a very bad immune system, then there is a chance that basilar could multiply a lot in the body. It can involve many nerves. So, as I said, the nerves get involved. So, muscle weakness happens. So, then there are chances of getting deformities, because you're not able to feel the sensation. So, there are a lot of deformities of the hands, feet, especially on the feet, because you're not able to feel the sensation. You can get something called ulcers, chronic ulcers on your feet. Then there are complications because of reactions. Now, because the bacteria are foreign in our body, our body is trying to fight it. So, body is trying to mount an immune response. And majority of the times, the symptoms that occur are because body is trying to fight this basilar. So, patients may come with fever. They may have severe pain along their joints, along the limbs. They may have a lot of red nodules, patches coming up on the body going. And in general, it can also affect inside the eyes, because the small movements, actually what happens is the nerve sensation of these muscles around the eyes get affected. So, patients are not able to close their eyes. So, eyes stay open. So, you may get ulcers in the cornea or the eyes, iritis, which is another eye complication. So, these are the complications which you can see if the symptoms are neglected at an early stage. The first step would be a proper clinical examination. The second would be a biopsy of the skin patch. Now, if there is a no-skin patch, but patients just coming with nerve symptoms, then the doctor may also recommend a nerve biopsy. When we do the nerve biopsy, we send it for a histopathological examination to look out for this bacilli in the body. Possebacillary, if you have two or fewer lesions, the treatment recommended is for six months. There are three drugs which are given and you have to take it for six months. Now, this treatment can extend up to a year and for multi-bacillary leprosy, where there are more than five lesions, you have to take the treatment for a year which can go up to two years. In addition, there has to be routine investigations that has to be done so that, you know, you don't develop any side effect to the medications so the patients will be constantly monitored. If you develop any reaction, that is the body is trying to fight the bacilli, then the additional treatment for the reaction also has to be given. In addition, if you have any nerve symptoms or any early onset of weakness, motor weakness, then physiotherapy is also added. Suppose in a family, one member is being detected with a leprosy, then we do a screening of the other family members by examining so they have to come to the doctor, their proper clinical examination has to be done and they are kept under observation. Other than that, if a person is a case of a multi-bacillary leprosy, like he has a lot of bacilli in the body, then there is a chance that he may be able to transmit the bacilli to his other close contacts. So he needs to wear a mask and avoid any close proximity with the other members.