Editing Leprosy (section)

== Signs and symptoms ==
Common symptoms present in the different types of leprosy include a runny nose; dry [[scalp]]; eye problems; skin [[lesion]]s; muscle weakness; reddish skin; smooth, shiny, diffuse thickening of facial skin, ear, and hand; loss of sensation in fingers and toes; thickening of [[Peripheral nervous system|peripheral nerves]]; a flat nose from the destruction of [[nasal cartilage]]s; and changes in [[phonation]] and other aspects of speech production.<ref>{{Cite web|url=https://www.cdc.gov/leprosy/symptoms/index.html|title=Signs and Symptoms {{!}} Hansen's Disease (Leprosy) {{!}} CDC|date=22 October 2018|website=www.cdc.gov|access-date=22 July 2019|archive-date=22 July 2019|archive-url=https://web.archive.org/web/20190722225129/https://www.cdc.gov/leprosy/symptoms/index.html|url-status=live}}</ref> In addition, [[atrophy]] of the testes and [[Erectile dysfunction|impotence]] may occur.<ref>{{Cite web|url=https://internationaltextbookofleprosy.org/chapter/pathology|title=Pathogenesis and Pathology of Leprosy|date=11 February 2016|website=International Textbook of Leprosy|access-date=22 July 2019|archive-date=22 July 2019|archive-url=https://web.archive.org/web/20190722225142/https://internationaltextbookofleprosy.org/chapter/pathology|url-status=live}}</ref>

Leprosy can affect people in different ways.<ref name="WHO2018Tx" /> The average [[incubation period]] is five years.<ref name="WHO Fact Sheet" /> People may begin to notice symptoms within the first year or up to 20 years after infection.<ref name="WHO Fact Sheet" /> The first noticeable sign of leprosy is often the development of pale or pink coloured patches of skin that may be insensitive to temperature or pain.<ref name="WHO">{{cite book|url=http://www.searo.who.int/entity/global_leprosy_programme/publications/8th_expert_comm_2012.pdf |archive-url=https://web.archive.org/web/20130805125140/http://www.searo.who.int/entity/global_leprosy_programme/publications/8th_expert_comm_2012.pdf |url-status=dead |archive-date=5 August 2013 |access-date=9 May 2018 |date=2012 |title=WHO Expert Committee on Leprosy – Eight report |publisher=[[World Health Organization]] (WHO) |isbn=978-9241209687 |pages=11–12}}</ref> Patches of discolored skin are sometimes accompanied or preceded by nerve problems including numbness or tenderness in the hands or feet.<ref name="WHO" /><ref>{{cite journal | vauthors = Talhari C, Talhari S, Penna GO | title = Clinical aspects of leprosy | journal = Clinics in Dermatology | volume = 33 | issue = 1 | pages = 26–37 | date = 2015 | pmid = 25432808 | doi = 10.1016/j.clindermatol.2014.07.002 }}</ref> [[Secondary infection]]s (additional bacterial or viral infections) can result in tissue loss, causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body.<ref name="Kulkarni2008">{{cite book |title=Textbook of Orthopedics and Trauma |edition= 2nd |page=779 |publisher=Jaypee Brothers Publishers |year=2008 |isbn=978-81-8448-242-3 |author=Kulkarni GS}}</ref><ref name="Q and A about leprosy">{{cite web |url=http://www.leprosy.org/leprosy-faqs |title=Q and A about leprosy |work=American Leprosy Missions |quote=Do fingers and toes fall off when someone gets leprosy? No. The bacillus attacks nerve endings and destroys the body's ability to feel pain and injury. Without feeling pain, people injure themselves on fire, thorns, rocks, and even hot coffee cups. Injuries become infected and result in tissue loss. Fingers and toes become shortened and deformed as the cartilage is absorbed into the body. |access-date=22 January 2011 |url-status=live |archive-url=https://web.archive.org/web/20121004072853/http://www.leprosy.org/leprosy-faqs |archive-date=4 October 2012 }}</ref> A person's immune response differs depending on the form of leprosy.<ref name="de SousaSotto2017">{{cite journal | vauthors = de Sousa JR, Sotto MN, Simões Quaresma JA | title = Leprosy As a Complex Infection: Breakdown of the Th1 and Th2 Immune Paradigm in the Immunopathogenesis of the Disease | journal = Frontiers in Immunology | volume = 8 | pages = 1635 | date = 28 November 2017 | pmid = 29234318 | pmc = 5712391 | doi = 10.3389/fimmu.2017.01635 | doi-access = free }}</ref>

Approximately 30% of people affected with leprosy experience nerve damage.<ref name="Rei2019" /> The nerve damage sustained is reversible when treated early but becomes permanent when appropriate treatment is delayed by several months. Damage to nerves may cause loss of muscle function, leading to paralysis. It may also lead to sensation abnormalities or [[numbness]], which may lead to additional infections, ulcerations, and joint deformities.<ref name="Rei2019">{{cite journal | vauthors = Reinar LM, Forsetlund L, Lehman LF, Brurberg KG | title = Interventions for ulceration and other skin changes caused by nerve damage in leprosy | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD012235 | date = July 2019 | issue = 7 | pmid = 31425632 | pmc = 6699662 | doi = 10.1002/14651858.CD012235.pub2 }}</ref><gallery mode="packed">
File:Tuberous Leprosy Wellcome L0032810.jpg|Face severely deformed by leprosy, 1895
File:Leprosy deformities hands.jpg|Hands deformed by leprosy, 2022
File:Fox Plate XL.jpg|Face mildly deformed by leprosy, 1905
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