Leprosy Mailing List – March 10, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Marco Andrey Cipriani Frade, Ribeirão Preto, Brazil
Dear Pieter,
Dr Jaison (LML, March 9, 2016) touched exactly an uncomfortable point about leprosy classification and he has my complete agreement.
According the simple scheme, considering just the number of lesions and neglecting the nerve impairment, we are losing the chance to do an early diagnosis and the correct treatment of leprosy and really cure these patients before disabilities and incapacity.
Nowadays, the number of patients with borderline profile and with small number of skin lesions, many almost imperceptible, but with restrict neural branches impairment with islet of sensitivity alteration(s) (tactile, pain and/or hot), and/or sympathetic alteration. Sympathetic alteration defined as restricted areas (islet) with no vasomotor reflex to endogenous or exogenous histamine stimulus and/or sweat dysfunction defined by (the absence of) natural beads of sweat or using lugol test. None of these details and detailed peripheral nerve clinical exam are described in routine protocols.
With MDT leprosy became a simple disease to treat, but its diagnosis continues or became more complex. Sure, we should think strongly about it and propose a more elaborated continuous educational program in leprosy clinic mainly in these early neural signs preventing the advance and the consequent notoriety of stigmas that both committed leprosy patients.
Best regards
Marco Andrey C. Frade
President of Brazilian Society of Leprology
Prof. Dr. Marco Andrey Cipriani Frade
Professor Associado (Livre Docente)
Coordenador Residência Médica de Dermatologia HCFMRP-USP
Coordenador Centro de Referência em Dermatologia Sanitária - Hanseníase - HCFMRP-USP
[(http://lattes.cnpq.br/9103136155056414)]
Divisão de Dermatologia - Departamento de Clínica Médica
Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo
Av. Bandeirantes, 3900 - Monte Alegre - Ribeirão Preto -SP - Brasil
CEP: 14.049.900 - Tel: 55-16-36022441 (Sala) - 36022447 (Sec.) - FAX: 55-16-36021522
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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