Video Blog: It Still Exists! A Hansen’s Disease Primer For The Non-Leprologist

In this video blog, Adam Lipworth, MD, discusses highlights from his lecture, It Still Exists! A Hansen’s Disease Primer For The Non-Leprologist, on July 27, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.

In this video

Dr. Lipworth reminds clinicians that Hansen's disease still exists and, as Richardson's mentor put it, "your eyes only see what your mind knows" — if it's not in your mind, you'll miss it. He isn't advocating that providers consider it for every patient, but for a small minority something in the back of the mind should be triggered, because when the diagnosis isn't made in a timely manner it leads to severe and permanent disability. He lays out four features to watch for: characteristic papules and plaques (especially plaques that are anesthetic and anhidrotic — no sensation, no sweating), nerve dysfunction of the large named nerves, nerve enlargement (a palpable ulnar, median, or sural nerve), and acid-fast bacilli on biopsy. Any two of those four should prompt clinicians to think about Hansen's disease.

On epidemiology, he cautions that apparent "hotspots" in CDC data are largely an artifact of where the National Hansen's disease program clinics are located, clustering around cities like Boston and Baton Rouge. Real risk concentrates where there is zoonotic transmission from armadillos (the southeastern US through Texas) and where there are high concentrations of immigrants from endemic countries such as Brazil, Cape Verde, and India. He stresses that providers should not manage this disease on their own — the roughly 15 federally funded National Hansen's disease clinics, headquartered in Baton Rouge, are "very willing and ready to help," which matters because the most affected patients are also the most vulnerable and underserved.

• Keep Hansen's disease in the back of your mind for the rare patient — a delayed diagnosis leads to severe and permanent disability.
• Watch for four features: characteristic papules and plaques, nerve dysfunction of large named nerves, nerve enlargement, and acid-fast bacilli on biopsy — any two should prompt suspicion.
• Anesthetic, anhidrotic plaques and palpable enlargement of cutaneous nerves (ulnar, median, sural) are unusual findings in dermatology and should raise the flag.
• Apparent geographic hotspots are largely an artifact of where the clinics are; true risk concentrates around armadillo zoonotic transmission and immigrants from endemic countries.
• Don't manage it alone — contact one of the ~15 federally funded National Hansen's disease clinics (headquartered in Baton Rouge) for expert help caring for these underserved patients.