Introduction Leprosy reactions are immunological complications that may occur before, during, or after completion of multi-drug therapy. Erythema nodosum leprosum (ENL), or type-2 reactions, are painful and characterised by fever, skin nodules, and involvement of organs such as joints and eyes. Social transfigurations in health refer to an exploratory lens to describe the profound changes in social identity and status due to illness. Social transfiguration in leprosy is often associated with negative social attitudes, stereotyping, and discrimination, leading to social isolation. Results Examining the lived experiences of an Indonesian man and an Indian woman illustrates the realities of physical transformations due to illness, whereby the embodiment of ENL and concurrent social relationships can reproduce and reinforce an imagined wellness that may be unattainable. The unpredictable occurrence of ENL can delay care-seeking, increase stigma, and disrupt familial and social connections. The embodied, gendered and temporal dimensions of the transfigured body also draw attention to the cultural and social norms that render the body an (in)disposable contributor to the household. Conclusion This paper highlights how ENL is related to bodily life through the lens of sociality and its transfiguration on health and illness. Service providers mindful of affected individuals’ unique experiences could consider the implementation of structural changes in ENL care, such as inpatient support, self-care groups, and integrating social support, which might improve the lived experience of affected individuals.

Background Painful neuroma and phantom-limb pain (PLP) are common, debilitating complications after lower-extremity amputation, yet their frequency in people with leprosy is largely unknown. Leprosy is associated with prolonged deafferentation, which may alter peripheral and central pain processing mechanisms, potentially reducing the risk of post-amputation pain. This study evaluated the expert-reported prevalence of painful neuroma and PLP in patients with leprosy who underwent below-knee amputations (BKA). Methods We conducted a cross-sectional, web-based survey between 06/2024 and 04/2025 involving 14 global leprosy specialists, each with over 10 years of clinical experience managing leprosy-related amputations. The structured questionnaire, distributed via REDCap, captured the estimated prevalence of painful neuroma and PLP in leprosy patients with BKAs, as well as comparative data from non-leprosy amputees managed by the same clinicians. Results All 14 respondents provided data on painful neuromas, and 11 provided data on PLP. Painful neuromas in leprosy amputees were reported at significantly lower rates than in non-leprosy amputees (p = 0.002), with most clinicians indicating frequencies in the 0–16% range. PLP was also skewed toward low prevalence, but the difference compared to non-leprosy patients was not statistically significant (p = 0.25). Conclusion Expert opinion suggests that leprosy-related BK amputees experience markedly fewer painful neuromas and modestly less PLP than amputees without leprosy. These findings suggest unique neuropathic adaptations in leprosy patients, possibly due to chronic deafferentation.

Leprosy self-care is essential for preventing disability and preserving dignity but remains challenging in resource-constrained settings like Nigeria. Traditional behavioural approaches often fail to address the broader social and material factors influencing self-care sustainability. This study employs Social Practice Theory (SPT) to reconceptualise leprosy self-care as a socially embedded practice, moving beyond individual-focused interventions. Conducted over four months in a leprosy-designated village in North Central Nigeria, the research utilised a qualitative methodology grounded in hermeneutic phenomenology. Data were collected through 20 in-depth interviews with individuals affected by leprosy, five key informant interviews, and 16 hours of non-participant observation. Thematic analysis, guided by SPT’s framework of competences, materials, and meanings, revealed that self-care is shaped by dynamic interactions among skills, resource availability, and cultural interpretations. Challenges included inadequate supplies, inconsistent healthcare support, and stigma, which often undermined engagement. Religious practices and daily routines, such as ablution, sometimes supported self-care, while competing activities like street begging posed barriers. The study distinguishes between replaceable and irreplaceable materials, highlighting their impact on practice sustainability. Family and peer involvement further influenced outcomes, either reinforcing or weakening self-care efforts. By framing self-care as a social practice, this research underscores the need for systemic, contextually sensitive interventions that integrate material provision, skill development, and stigma reduction. SPT offers a robust framework for designing multi-level strategies to enhance self-care for leprosy and other chronic conditions, promoting sustainable health outcomes in marginalised communities.

Background S-100 immunostaining is used to highlight the nerve elements and to illustrate nerve changes in the spectrum of leprosy because in some cases nerve fibers may not be easily identifiable on routine H&E stain. This study was conducted to determine the pattern of nerve damage in cutaneous biopsy of leprosy patients using S100 and its association with Ridley-Jopling classification. Methodology Skin biopsies of leprosy patients were processed and stained with H&E, FF, and S-100. H&E slides were evaluated and classified using Ridley-Jopling classification. S100 staining patterns of nerves were analyzed across clinico-histologically defined forms of Hansen’s disease: TT, BT, BB, BL & LL. Results The mean age of cases was 35.07 ±13.71 years, with a M:F ratio of 2.1:1. Hypopigmented lesions were the most prevalent (46.6%), with 89.8% of cases having reduced sensation over lesions. Granuloma was seen in ∼52% of cases. AFB was demonstrated in 30% of biopsies using ZN stain and 39% using FF stain. Histopathologically, LL cases comprised the majority (29.5%), followed closely by BT and BL. S100 staining revealed absent pattern as the most common in LL; in TT we got infiltrated/fragmented pattern or their combination; in BL we got absent or infiltrated pattern; and in BT, fragmented pattern was most common. Conclusion S-100 immunostaining can be used as an adjunct to Fite-Faraco stain, especially in tuberculoid and borderline tuberculoid leprosy, where FF stain usually fails to demonstrate bacilli, and also in those granulomatous skin biopsies where other differential diagnoses of granuloma cannot be excluded convincingly.

Background Dapsone is an essential component of multidrug therapy (MDT) for Hansen’s disease but is associated with rare, potentially life-threatening adverse events such as Dapsone Hypersensitivity Syndrome (DHS). Case We report a 67-year-old male with borderline tuberculoid leprosy who developed generalized exfoliative dermatitis, fever, eosinophilia, hepatosplenomegaly, and hypoxia three weeks after starting MDT. Cutaneous examination revealed diffuse skin exfoliation sparing old Hansen’s plaques, along with a trophic ulcer and nerve tenderness. Investigations showed leucocytosis, transaminitis, and CT scan findings consistent with hypersensitivity pneumonitis. MDT was withheld, and the patient was managed with systemic corticosteroids and oxygen support. Clinical and biochemical parameters improved, and MDT was reintroduced without dapsone under steroid cover. Conclusion DHS may mimic a Type 1 lepra reaction, leading to diagnostic difficulty. Early recognition and prompt management are crucial to prevent severe complications. This case underscores the importance of considering DHS in patients presenting with systemic symptoms following dapsone initiation.

Leprosy, caused by Mycobacterium leprae, remains a public health concern in endemic regions like Pekan, Malaysia, particularly within indigenous communities. Children are highly vulnerable to transmission, often through household contact, especially with multibacillary (MB) cases. Early diagnosis and treatment are crucial to prevent long-term disabilities. This report highlights a rare case of a 6-month-old infant from Pekan, clinically diagnosed with paucibacillary leprosy, making her potentially the youngest reported case in Malaysia.