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weeks. There is no recurrence. Symptomatic treatment in the form of liquid paraffin for external applications and oral antihistaminics are sufficient.

Hansen's disease: Hansen's disease is a chronic, mildly contagious, primarily involving the peripheral nerves, secondarily involving the skin, the mucous membrane! of upper respiratory tract, eyes, bone, testes, reticulo-endothelial system and other organs except brains, spinal cord, gall bladder and ovaries. Infection is disseminated through the blood stream and lymphatics. The Schwann cells act as biological refrigerators and organism remains alive within Schwann cells for years together.

In 1960, the mycobacteria leprae were grown in the foot pads of mice. It was seen that human beings are the only natural hosts. With genetic susceptibility in the background, the disease spreads through prolonged direct physical contact, basal secre. tion and breast milk.

Hansen's disease is classified into 5 types viz., (i) Tuberculoid (ii) Borderline Tuberculoid (iii) True borderline (iv) Borderline lepromatous and (v) Lepromatous.

(i) Tuberculoid Hansen: Solitary or 2 to 3 erythematous coppery patches with flat or raised edges. These show loss of pain, temperature, touch from the beginning of the illness. Peripheral nerves including unnamed cuaneous nerves are thickened.

(ii) Borderline Hansen: Consists of multiple, asymmetrical lesions irregular in size and shape associated with thickening of nerves.

(iii) Lepromatous Hansen: This is characterised by macules in the early stages, infiltrative lesions and nodules. All the three types of lesions can occur in the same individual. They are usually symmetrical and occur in the cooler areas of the body. The scalp, perineum and axilla are called immune areas for lepromatous Hansen. Sensory loss occurs often in the distal parts of the limbs. The skin, usually of the hand is shiny and oedematous, due to lack of vasomotor tone. There is stuffiness of the nose and ulceration of the oral cavity. Chronic iridocyclitis may lead on to loss of vision. Complications like trophic ulcers due to anaesthesis, claw hand, wrist or foot drop and facial palsy occur.

According to WHO, single drug therapy is to be deferred so as to prevent emergence of resistant strains. In non-lepromatous types, Dapsone 100 mgs/ day, on all 7 days of a week and rifampicin 600 mgs once a month are administered. In lepromatous type, Dapsone 100 mgs/ day, Clofazimine (Lampren) 50 mgs/ day or 100 mgs on alternate days and Rifampicin 600 mgs once a month are the treatment of choice. The advantages of a multiple drug therapy are that such a therapy prevents the emergence of resistant strains of bacteria, the spread of infection is checked rapidly as the bacilli are destroyed in a few months time. 1 capsule of Rifampicin can kill 75 to 80% of the bacilli. Within 3 months time an individual becomes negative for the bacilli with Rifampicin, while Dapsone takes 2 years. Also the duration of treatment can be shortened remarkably, with only 6 months in non-lapromatous type and about 2 years or until smear negative with Dapsone. When all signs have disappeared or when biopsy shows no granuloma in the dermis, the treatment could be stopped.

BCG vaccine in Hansen's disease :

BCG vaccine administration leads on to a lepromin positive stage in the individual. When a lepromin positive individual is exposed to Hansen, he develops the less harmful types like tuberculoid Hansen while a lepromin negative individual develops the more harmful borderline or lepromatous Hansen's disease.

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