LEPROSY COMPLICATIONS

Complications of leprosy are the reactions which cause nerve damage
and the sequelae of this nerve damage; loss of sensation and loss of
muscle strength, with ulceration and deformity as consequence.
Reactions
Two types of reactions are recognised, the Reversal Reaction (RR) and
Erythema Nodosum Leprosum (ENL). Symptoms of a RR can be
increased swelling with erythema of previously existing lesions, the
appearance of new lesions, enlargement and tenderness of nerves which
may show increased function loss, and sometimes acral edema. The
ENL-type reaction, in its characteristic form, shows a sudden appearance
of tender erythematous nodules. The patient often feels ill. Nerves
may be tender. Sometimes arthritis occurs, or lymphadenitis, orchitis may
be encountered as well as iridocyclitis and glaucoma which can lead to
blindness. Organs may be involved separately or simultaneously.
Ulceration and deformity
Ulceration is secondary to the loss of protective sensation. The patient
feels no heat, pressure or pain. Skin trauma is not felt and easily
neglected. The risk of damage increases when there is loss of muscle
strength (claw hand, drop foot). Ulceration may lead to cellulitis or deep
infections, osteomyelitis and consequently to loss of digits.
When there is lagophtalmos, there is usually also anaesthesia of the eye
and consequently there is no blink. The eye is at risk of drying out and
ulceration with blindness may be the final result.
Deformity is the result of loss of muscle strength and ulceration
followed by osteomyelitis and shortening of digits, mostly accompanied
by stiffness and contractures.