Three million persons are affected by nerve damage caused by leprosy (Hansen's disease) worldwide. Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae. About 30% of people with leprosy develop nerve damage that can lead to loss of normal sensation and skin damage. The skin can crack and become infected and ulcerated. Impairment of the affected limb, caused by nerve damage, can result in severe joint deformity and injuries. The major areas affected by sensory loss are the hands (especially the palms), feet (especially the soles) and eyes. The drug therapy offered to those with leprosy is efficacious and has low relapse rates. However, even with treatment, many with leprosy will go on to develop secondary damage to skin and limbs as the nerve damage sustained cannot be reversed. In some, treatment leads to inflammatory reactions in the nerves, sometimes resulting in further damage.
Many interventions may help the healing of such ulcers. The rationale behind the use of, for example, appropriate footwear is to protect feet from damage that can lead to superficial sores on the soles of the feet, and later ulcers and secondary infections. Self-care includes daily management to reduce the effects of nerve function impairment. Education, information and empowerment of those affected by leprosy (and their carers) is part of some leprosy programmes and might prevent ulcers developing. Dressings might enhance the healing of ulcers.
We included eight trials with a total of 557 participants. Based on weak evidence we suggest that dressings with topical ketanserin may be more effective than clioquinol cream or zinc paste and topical phenytoin may be more effective than saline dressings regarding ulcer healing. Canvas shoes seem to be a little better than PVC-boots, but not significantly. Double rocker shoes do not show statistically significant benefit compared to below-knee plaster in promoting healing of ulcers. Whether the interventions reduce social stigma and lead to better quality of life were not investigated in any of the eight trials in this review. No side effects were documented.
There is a lack of high quality research in the field of ulcer prevention and treatment in leprosy. New trials should follow the current standards for design and reporting of randomised controlled trials.