Lepra Bonita (Pretty Leprosy)
If you’re looking for a way to get prettier and don’t want to spend on makeup and other expensive beauty products, then this disease will intrigue you! This variant of leprosy will make your skin glow, eliminate wrinkles, and you’ll look as pretty as a September peach at your own funeral ( P.S: the disease isn’t fatal but the pain is quite unbearable.)
Leprosy
Leprosy (Hansen’s disease) is also widely recognized as death before death. It is a chronic, progressive bacterial infection affecting the nerves of the extremities, the skin, the lining of the nose, and the upper respiratory tract. It is one of the oldest diseases known to mankind and can cause major disfigurement, disabilities, and death when left untreated. This disease has many variants, and pretty leprosy is a subvariant.
The beauty variant of leprosy
Described by Dr. Rafael Lucio in 1853, ‘pretty leprosy’, also known as Diffuse lepromatous leprosy, is triggered by many agents that can be streptococcal, cryptococcal, respiratory infections, drugs (iodide, chaulmoogra oil, etc.) and pregnancy. This variant is rare but severe, and manifests itself as pale macules in the skin. It’s predominantly common in Mexico, Costa Rica, Brazil and Columbia.
Pathogenesis
Mycobacterium leprae is the leprosy causing pathogen. The most putative pathogenesis for this disease is the free replication of M. leprae or M. lepromatosis in the endothelial cells and greater exposure of mycobacterial antigens to circulating antibodies, causing inflammation of blood vessels (vasculitis) and tissue death due to inadequate blood supply (infarction). This, accompanied by inflammatory reactions and changes in the coagulation system, causes clotting in veins (vascular thrombosis), restricted blood supply to the tissues (ischemia) and tissue necrosis, which is also termed as Lucio’s phenomenon.
Clinical Features
The disease is called ‘pretty leprosy’ since the skin becomes wrinkleless and looks younger. The prominent infiltration into the auricular lobes makes it thick, and the oedematous appearance of the face makes it look healthy. The formation of nodules stop, accompanied by madarosis (loss of eyelashes) and alopecia of eyebrows and body hair. The intrusion of mucosa leads to chronic rhinitis (inflammation and swelling of the mucous membrane of the nose) with epistaxis (bleeding from the nose), septum perforation and obliteration of nasal passage. Tongue thickens, upper incisors weaken (and often drop out) with the presence of hoarseness. The body loses the ability to sweat. In the later disease progression, the hands become swollen and red, and the legs become oedematous. The skin in the advanced cases becomes cigarette paper like.
Diagnosis
Skin biopsy is widely used to diagnose the disease. If you have symptoms of leprosy, Lepromin skin test maybe ordered with skin biopsy to confirm the presence and type of leprosy. A lepromin skin test is performed by injecting a sample of inactivated M. leprae under your skin and you’ll be examined after 3 days to see if you had a reaction to the bacterium. Specific reactions at the injection site indicate certain type of leprosy. If you have tested positive for leprosy during the biopsy and the skin shows no reaction to the lepromin skin test then, it indicates that you may have lepromatous leprosy. The lab studies observed in Lucio’s phenomenon are anaemia, an elevated erythrocyte sedimentation rate, hypoalbuminemia (low level of albumin in blood), hypergammaglobulinemia, false-positive serological reactions for syphilis, positive rheumatoid factor, mixed type cryoglobulins, circulating immune complexes and hypocomplementemia.
In the case of a patient from Mexico, a skin biopsy on the chin was performed. The histopathology exhibited extensive infiltration of histiocytes in the skin appendages and a small nerve. A Fite stain revealed a moderate number of acid-fast bacilli (M. leprae and M. lepromatosis) in the skin tissue, with additional locations in the endothelial and a nerve. These results proved the diagnosis of diffuse lepromatous leprosy.
Treatment
There is no specific treatment for Lucio’s phenomenon. The treatment is the same as for the normal cases of leprosy, i.e., the anti-leprosy therapy. This therapy is a multidrug regimen consisting of rifampin, dapsone and clofazimine. This therapy, along with optimal wound care and treatment for bacteraemia, including antibiotics, is sufficient to cure the patient.
Conclusion
Leprosy is one of the oldest diseases that humankind has been fighting, and even now, we barely understand it. Pretty leprosy is the subvariant of leprosy, caused by M. leprae causing vasculitis and infarction. Though this disease has ‘pretty’ in its name, and the skin might get a younger and wrinkle-free look, the patient has to greatly suffer through the ailment just like in every other variant of leprosy. Once diagnosed, this disease is easy to treat, and the patient can be cured.
