Skin Biopsy in the Diagnosis of Hansen’s Disease

In the bible, persons afflicted with the Hansen’s disease are cursed for life. The disease was thought to be a curse for sinful ways. These persons are banished to remote leper colonies and separated from the rest for fear that they might spread the disease. Some were even stoned to death.

In 1873, Dr. Armauer Hansen of Norway discovered that Hansen’s disease was caused by a bacterium known as bacterium (Mycobacterium leprae).

What is Hansen’s Disease?

Hansen’s Disease is now commonly known as leprosy. It is considered as a chronic infectious disease. As examined under the tissue culture microscope, it is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract. Usually skin lesions are the main external symptom. Samples can be taken from these lesions for further study using the tissue culture microscope. In untreated, the disease can be progressive and eventually cause permanent damage to the skin, nerves, limbs and eyes. To better understand the disease, it is better to study it extensively with the aid of the tissue culture microscope.

Mode of transmission

Leprosy is known to be spread when an untreated infected person coughs or sneezes. It is not spread through sexual contact or pregnancy. Leprosy is not very contagious because almost 95% of the people have natural immunity to it. Even people who are treated need not be isolated from society.

Signs and symptoms

Warning signs should be closely monitored. Most often the earliest sign of leprosy is a spot on the skin that may be slightly redder, darker, or lighter than the person’s normal skin. When these signs occur, it is suggested that tissue samples be taken and examined under the tissue culture microscope. The skin spot may lose feeling and hair. For some, the only manifestation is numbness in a finger or toe.

The clinical signs for leprosy may vary. However, it usually affects the skin, nerves as well as the mucous membranes. As the skin is the common site, once leprosy is suspected, tissue samples should be immediately examined in the tissue culture microscope. Should the result be positive, medical interventions can be immediately prescribed.

Classifications for the disease

Persons afflicted with the disease have different clinical manifestations. However, leprosy is known to affect the skin, nerves as well as the mucous membranes. Lepers are classified as having paucibacillary, multibacillary or borderline leprosy.

Paucibacillary is otherwise known as tuberculoid leprosy. Tissue samples taken and examined under the tissue culture microscope show that this type is characterized by one or more hypopigmented skin macules and anesthetic patches. The disease has damaged the peripheral nerves brought about by the attack of the human host’s immune cells.

As studied in the tissue culture microscope, the multibacillary type is associated with symmetric skin lesions, nodules and plaques. The dermis is thickened. Most often the nasal mucosa is affected and this results to nasal congestion and nose bleeds or epistaxis.

Borderline leprosy is also referred to as multibacillary, of intermediate severity. It is the most common form of leprosy. As viewed under the tissue culture microscope, the skin lesions appear as tuberculoid leprosy but are more numerous and irregular. The large patches may affect a whole limb. The peripheral nerve is also affected with weakness and loss of sensation. Borderline leprosy is considered unstable and may become more like lepromatous leprosy. It may also undergo a reversal reaction, becoming more like the tuberculoid form.

The Importance of Biopsy

Biopsy is an important tool in the diagnosis and type classification of Hansen’s disease. Biopsy can be performed using modern laboratory equipment and apparatus like the tissue culture microscope. There are important factors to be considered before performing a biopsy. One critical factor is the proper site for the skin biopsy. The pathologist will not be able to make a conclusive diagnosis if the bacilli cannot be demonstrated with the use of the biopsy.

The rule is that the biopsy should be taken entirely within the lesion. Normal tissue is not needed in the biopsy. Should there be multiple lesions, it is advisable to take them all as samples. In the event that no definite lesion can be located, the choice of the site should be based on the information taken from skin scrapings examined under the tissue culture microscope as well as clinical findings like decreased sensation or sweating.

It is likewise important to perform biopsy with a biopsy punch or surgical excision. It should include the subcutaneous fats because most often the prominently involved nerve is located in the upper portion of the subcutaneous tissue. Surgical excision on the other hand is done with a cold knife.

More importantly, adequate clinical information should always be submitted with the specimen. Relevant information includes data on number of lesions, changes in sensation previous diagnosis and present clinical impressions and the like. Treatment available

With the advancements in the field of science especially in Medicine, it is now possible to cure leprosy. The WHO recommends a combination of three antibiotics namely dapsone, rifampin and clofazimine for six months or more treatments. In the course of the treatment, the body may react to the dead bacteria with pain and swelling in the nerves and skin. Doctors can prescribe pain medication, prednisone or thalidomide.