(LML) The Diagnosis of Leprosy, now that this disease has entered the mainstream of medicine

 

Leprosy Mailing List – June 27^th, 2012

Ref.:   The Diagnosis of Leprosy, now that this disease has entered the mainstream of medicine
From: H Srinivasan, Chennai, India

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Dear Dr Salvatore Noto,

Thank you very much to all colleagues discussing this topic.  Herewith are my comments.

For many many decades leprosy was treated as a public health problem for tackling which we depended almost entirely on nonmedical field staff.  Teaching leprosy has all along been constrained by this practical necessity, leading to many simplifications– like prescribing a certain number of cardinal signs for diagnosing the disease, categorizing the disease by the number of visible lesions, doing away with some diagnostic tools ("need not do a slit-skin smear examination as it is not practicable in the field in some or many places), standardizing treatment schedules and so on.  These simplifications have become dogmas and rigid formulas, hence such discussion as "whether you diagnose leprosy on one sign or two signs".

Now that the acuteness of leprosy as a public health problem has abated and management of this disease has entered the mainstream of medicine, teaching a complex disease like leprosy (complex in its clinical presentation, histopathology, immunology and management) needs to be made more 'realistic', not based on simplified rigid formulas with lopsided emphasis that have been used in the past, but just like the way we teach other complex diseases.  The latest contribution from Dr Van Brakel (LML June 20^th, 2012) proves my point.

Thanking you once again.

Regards,

H Srinivasan

H Srinivasan FRCS (Eng & Ed)
(Retired Surgeon)
25, First seaward Road
Chennai 600 041
South India

 

 

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LML - S Deepak, B Naafs, S Noto, P A M Schreuder                  
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83  -  Fax: (+39) 010 555 66 41  -  E-mail: salvatore.noto@hsanmartino.it