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Wound infections
Wound hygiene

Neuropathic ulcers in leprosy: clinical features, diagnosis and treatment

01 June 2022
Practice

Abstract

Leprosy is a neglected disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers—lesions that can appear at the plantar and extra-plantar levels—are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, which affects the skin and peripheral nerves.1 This disease has been associated with significant disability in the eyes, hands and feet.2 Neuropathic ulcers in leprosy are one such disability. These are lesions involving the skin and deep tissues, which tend to be located on bony prominences and have a marked tendency to recur.3

From an epidemiological perspective, in countries where leprosy is endemic, 20% of patients with leprosy develop ulcers at the plantar level, with 70% of these on the forefoot.4 However, there are no data on the prevalence of extra-plantar ulcers (skin lesions located outside on the soles of the feet), which are also lesions that significantly compromise the quality of life (QoL) of patients with leprosy; these ulcers are not considered by some control programmes.5 This limitation could be the consequence of two weaknesses that exist in the understanding of these ulcerative lesions, namely:

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debridement
diagnostic
leprosy
Mycobacterium leprae
neuropathic ulcer
plantar
therapy
ulcer
wound
wound care
wound healing
wound infection