Leprosy is an infectious disease caused by the bacillus Mycobacterium leprae (1).
Leprosy patients can experience deformities that affect sight, touch, and manual dexterity. Macules, papules, and nodules are prevalent among other skin lesions (2). Along with these symptoms, leprosy patients experience immense stigma and discrimination, also called leprostigma.
Leprosy can be cured using a combination of three antibiotics – rifampicin, clofazimine, and dapsone – widely known as multidrug therapy (MDT). This treatment, found in 1970, was officially recommended by the World Health Organization (WHO) in 1981 (3, 4). As a result of this discovery, in the year 2000, the global prevalence rate of leprosy cases reduced to <1 case per 10,000 population (5). However, leprostigma is still active in society, and in some countries, discriminatory leprosy-related policies are yet to be amended (6). Negligence has brought even more leprostigma, misconceptions, and deterrence to patient management and life quality in both endemic and non-endemic countries (7), and due to the COVID-19 pandemic, leprosy management has been further harmed due to a decrease in diagnosis, treatment difficulties, increase in stigma, and increased susceptibility of leprosy patients to COVID-19 (8–23).
There are some published papers on leprosy and leprostigma, but reviews on the present-day situation, especially the impacts of COVID-19, are lacking. This paper aims to provide a thorough overview of past leprosy and leprostigma, as well as highlight the present-day situation regarding patient management, discriminatory governmental policies, and impacts of the COVID-19 pandemic. An updated overview will help ensure proper care of patients in light of the recent pandemic and underscore the continued need for interest in leprosy management despite its perceived unimportance.
History of leprosy
Leprosy has existed for many centuries, but its origins are unknown (24). The disease has most likely spread around the world by human migrations such as relocation or colonization (25).
The origin of the term, leprosy, comes from biblical translations of Hebrew into Greek. The Hebrew word, “tsara’ath,” translated as “leprosy” in the authorized version of the Old Testament, is a non-scientific term that indicates ritualistic defilement instead of a specific skin disease (26). The Bible presents leprosy as a symbol that aggregates harmful consequences of impious behavior (27). Due to these presentations, leprosy was commonly misunderstood as hereditary and incurable and was considered as “a divine punishment or curse,” and this harmful image associated with the disease has resulted in inhumane treatments of patients such as leprosariums and mass executions (1, 24, 28, 29).
After the discovery of the bacillus M. Leprae as the cause of leprosy, countries set aims to eliminate leprosy. By providing MDT, an efficacious treatment based on the bacillus, to all government health facilities, the WHO successfully reduced the global prevalence of the disease (3, 4). However, complete elimination has yet to be reached as areas of high endemicity remain in many countries. For instance, in India, a country with more than 60% of the global burden of leprosy, the annual new case detection rate and prevalence rate per 10,000 people have remained nearly non-decreasing at 2.0 and 1.4, respectively, since 2007 (7).
