A New Atlas of Leprosy by A. Colin McDougall, Yo Yuasa

By A. Colin McDougall, Yo Yuasa

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Tokelau includes 3 atolls, Atafu, Nukunono and Fakaofo, positioned 750 miles northwest of Samoa. Tokelauan belongs to the Polynesian sub-group of Austronesian. it's spoken through approximately nearly 5000 humans, of whom approximately 1600 dwell within the atolls, approximately 3000 in New Zealand, and several other hundred in different places within the Pacific zone.

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Although not easily demonstrated, some of the larger patches showed loss of sensation to cotton wool. Skin smears were positive. Multibacillary (MB) leprosy. MULTIBACILLARY (MB) LEPROSY 17. The patient shows numerous ‘punched out’ lesions on the buttocks and legs and there are many similar lesions on the trunk and arms. Skin smears were positive. Most of the lesions showed loss of sensation to cotton wool testing and there were three enlarged peripheral nerves. Multibacillary (MB) leprosy. 27 28 MULTIBACILLARY (MB) LEPROSY 18.

Face and eyes. Upper picture; active MB leprosy showing thickened (infiltrated) and shiny skin on the face. The ears on both sides show infiltration and nodule formation. Eyebrows have disappeared (‘madarosis’; common in well-established MB leprosy of this kind, uncommon in other diseases). Lower left; active nodular MB leprosy with collapse of the cartilage of the nose (arrowed). Lower right; elderly patients with a long history of leprosy are most at risk to eye complications and blindness. This patient is unable to close the eyes to protect them, due to damage to the facial nerves on both sides.

Some patches showed slight loss of sensation to cotton wool testing. Multibacillary (MB) leprosy. MULTIBACILLARY (MB) LEPROSY 21. This is the back of the patient shown in Figure 20. In this form of (MB) leprosy, the lesions are typically raised and slope down towards the skin level at the edges, like an inverted saucer. This is in contrast to the findings in many of the PB patches shown in Figures 1–13. Multibacillary (MB) leprosy. 31 32 MULTIBACILLARY (MB) LEPROSY 22. The whole of the back and most of the arm surface show symmetrically distributed flat (macular) lesions.

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