Project coordination
Leonard Wood Memorial Center for Leprosy Research (Philippines)

Aim: This study aimed to assess whether skin lesions can be used as proxy indicaor to detect early signs of nerve function impairment in leprosy.

Full project title:
Inflamed skin lesions along an area of a peripheral nerve as a patient self-help proxy indicator in detecting early signs of nerve function impairment in leprosy

Final project summary:
Early detection of nerve damage is essential in the management of leprosy, as untreated nerve impairment can lead to permanent disability and deformities. This study explored whether people affected by leprosy could be empowered to monitor their own skin lesions using a simple assessment tool and identify skin changes that may indicate emerging nerve problems, particularly during leprosy reactions, when lesions become red, swollen, and painful.

The study also aimed to encourage patients to seek medical attention promptly when warning signs appeared, leading to earlier treatment and improved outcomes. In addition, it assessed whether a simple skin-monitoring tool would be practical and acceptable for use by patients.

This three-year study, completed in April 2020, involved 200 newly diagnosed leprosy patients, 91% of whom had multibacillary (MB) leprosy. All participants received standard WHO multidrug therapy (MDT). A total of 628 skin lesions and their corresponding nerves were examined, with approximately half of the lesions showing signs of inflammation, including pain, redness, and swelling.

Participants were trained to assess and score their own skin lesions using the monitoring tool. Their assessments were compared with independent evaluations conducted by a leprosy physician, while nerve function was assessed separately by another healthcare worker. To minimise bias, neither the patients nor the healthcare professionals had access to each other’s findings during the study.

The results showed that patient assessments were comparable to those made by physicians. The study also found a strong relationship between skin lesion scores and nerve function. As skin lesions became more inflamed and scored higher for redness, swelling, and pain, the nerves located beneath or near those lesions showed poorer function.

The findings further indicated that nerves located close to inflamed skin lesions were at greater risk of impairment than nerves located further away. This observation was supported by seven patients who developed visible deformities in areas associated with nerves near inflamed lesions. These abnormalities were identified early, were relatively mild, and resolved following prompt treatment with corticosteroids. No similar deformities were observed in nerves located distant from inflamed lesions.

Overall, the study suggests that changes in skin lesions can serve as a useful indicator of emerging nerve problems. Teaching patients to recognise and monitor these changes may help them seek medical care earlier, enabling timely treatment and reducing the risk of disability and deformity. The findings also demonstrate that patient-led skin monitoring is both feasible and comparable to clinician assessment, highlighting its potential value as a practical tool in leprosy care.

Impact

Balagon, M. F., Maghanoy, A. M., Roferos, F. O., & Saunderson, P. R. (2021). Inflamed skin lesions along the course of a nerve as patient self-help proxy indicator of nerve abnormalities in leprosy. Leprosy Review, 92(4), 385-397.