Ref.: (LML) What is PB leprosy?
From: Dr. Grace Warren, Sydney, Australia
Dear Pieter,
The Power-point entitled " what is PB leprosy" poses some interesting thoughts. It is an interesting collection of photos showing so many lesions that we so often see. However, the title is " What is PB leprosy" and this gives one the idea that the photos that follow will be PB leprosy, but I suspect that all the photos shown in that Power-point are not PB. They appear basically LL to me, or perhaps BL. I am afraid that with that as the title many readers who are not experienced will assume that the lesions are in fact paucibacillary leprosy or even assume they are all Indeterminate leprosy.
Yes, he does not actually state each is PB and at the end makes a good comment that true PB is probably very rare. However, I think that if this power-point is used for teaching purposes, it is necessary to add that there is no photo of him initially when he was first diagnosed as PB and that all these photos are taken years later when he is progressed as so many do, to full LL type leprosy.
I find that many of the younger doctors know so little about leprosy. They never suspect the very early hypopigmented lesions that are so typical of Indeterminate in some skin colours, nor do they look for the infiltrated lesions that often appear to have no edges at all but one can feel the thickening and if one looks for AFB one knows it is leprosy. Unfortunately because they do not have edges and loss of sensation these are often missed and leprosy is not considered. They are often lepromatous. Actually, they do not fit into any of the descriptions given by WHO as to " What is leprosy" .
There is a big place for availability of such collections for those who do not have suitable teachers available to assist them. Please, could it be possible to give a bit more teaching in order to clarify the situation and assist the younger workers to really look for leprosy and diagnose it timely.
In the other set of photos also by Dr Barreto (New case detection – delay in diagnosis) there are some lovely illustrations that could well be Indeterminate or have been Indeterminate, and now are developing on to determined leprosy. It may well have been good to include a typical I lesion in the set so students can see the contrast at the same time. I personally am fascinated at how often Indeterminate leprosy is left undiagnosed or misdiagnosed for some other skin disease.
All the best for Good teaching in the years ahead - we are going to need it.
Grace Warren
Previously Adviser in Leprosy and Reconstructive surgery for The Leprosy Mission in Asia
LML - S Deepak, B Naafs, S Noto and P Schreuder
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