Role of dermatologists in leprosy

The issue of the role of dermatologists in leprosy is being discussed increasingly in the recent past largely as a result of the changing scenario with regard to the disease. The changed situation in many parts of the world and particularly in India is that there are far fewer cases of leprosy to deal with as a result of the success of MDT and the leprosy elimination strategy pursued by leprosy endemic countries, with the active support of WHO and NGOs over the past 15 years or more. In public health terms, leprosy is a much smaller problem now than ever before. However, the new situation of having to deal with a smaller number of cases has thrown newer challenges as well as newer opportunities. Even as the leprosy elimination strategy was yielding good results the need for leprosy to be part of the general health service and general medical care was increasingly felt. This led to the increasing emphasis on integration of leprosy within general health services. While this integration approach is both logical and cost-effective, several issues related to patient care have come up which need to be addressed. Among the several issues the most important are (a) how do we maintain the needed skills at the peripheral or primary health care level to diagnose and treat leprosy accurately, (b) how do we deal with complications that need both the expertise as well as facilities for hospitalization and (c) how do we deal with problems of disability that need both surgical and other rehabilitative support. With these challenges in mind one can look at the emerging opportunities that might help in addressing them. In the past leprosy was part of the dermatologist’s portfolio and they did deal with leprosy patients as and when they came to them. However, the existence of a more specialized group with the name of leprologists made many patients seek the help of such single disease superspecialists. This was further reinforced by the fact that leprosy was essentially in the domain of public sector. This well justified domination of the public sector was due to (a) leprosy being an important public health problem, (b) leprosy involving a huge number of patients particularly in countries like India, (c) leprosy being considered as a very complex disease and (d) leprosy not being in the mainstream of medicine and medical care as a result of widespread social stigma. Lastly it should be added that leprologists themselves contributed to certain myths and mysteries of the disease as if no one other than themselves can handle the disease. However, it must be added that a significant number of dermatologists took a strong interest in leprosy and made valuable contributions even if such contributions were confined to clinical activities. Today the leprosy situation has greatly changed. In most parts of the world, currently leprosy is not considered to be a serious public health problem. Secondly, the absolute