Leprosy in children

Leprosy Mailing List, September 11th, 2008

Ref.: Leprosy in children
From: Ryan T., Oxford, UK


Dear Salvatore,
I refer to Dr Deepak’s LML message dated Sept. 5th, 2008. Very important to emphasise that anything that switches on repair of the epidermis accelerates its cell turnover and melanisation may not be able to keep up. Mild dermatitis is very common due a range of climate effects, infections and irritants. It results in hypopigmentation, so white patches in children are common (Pityriasis alba) and respond to emollients. Sweating is not pronounced in children and therefore its absence un helpful. The memory of leprosy has to be sown in every medical student and of course the basic skill of sensory testing.

In Children, facial pityriasis alba cannot so easily be distinguished since the facial innervation defects in leprosy white patches in children are difficult to define. One hesitates to biopsy a child's face but persistent white patches else where on the body, not responding to emollients or antifungals should be biopsied. As has been pointed out by Margaret Lockwood in the UK the memory of leprosy is often triggered by the Dermatologists habit of taking a biopsy.

This is a preface to ask you not to focus on this rare disease out of context of the many other causes of skin disease but to emphasise the importance of the skin, its barrier function, communication role, themoregulation, and sensory function and encourage them to avoid the ignorance that prevails world wide on how to manage it.

Most of dermatology's textbooks and Internet are well equipped to answer questions on the diagnosis of skin lesions in Children. Think of leprosy should be the main teaching point.

Terence Ryan