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Cases of leprosy can be misdiagnosed as commoner skin conditions, dermatologists from Cardiff warned, citing two cases that had been misdiagnosed as erysipelas and discoid eczema. Both patients were subsequently diagnosed by dermatologists as having leprosy and referred to infectious disease specialists for appropriate treatment. Both had moved from Asia within the past few years.

Leprosy is a chronic infection caused by Mycobacterium leprae and Mycobacterium lepromatosis, which results in lesions on the skin and diminished or loss of sensation in the affected areas.

Symptoms can occur years or even decades after initial infection. The characteristic damage to the hands, feet and face is not caused by the disease itself but by the loss of sensation in those areas. Minor trauma such as burns, scratches or something as simple as a stone in a shoe, can go unnoticed and result in serious injury and infection.

Leprosy is not highly contagious and it is not fully known how it is passed from person to person but it is thought to be via droplets from the nose and mouth. The spread of leprosy is caused by close and frequent contact between a person who is genetically susceptible to developing the disease and an untreated patient.

It is a relatively rare disease with approximately 232,000 cases reported annually worldwide, the majority of which occur in south-east Asia. Between 2001 and 2010, 129 cases were reported in England and Wales.

Dr Ausama Atwan, one of the reporting clinicians in Cardiff, said leprosy is something that doctors should keep in mind, especially if they encounter patients coming from countries where the disease is endemic, who have persistent or unexplained lesions and changes in skin pigmentation and sensation.