Hormone treatment is only useful for women with acne. This treatment is based on the fact that acne often starts at puberty and may worsen just prior to a woman’s period. It may improve during pregnancy and when taking a high oestrogen, low progestogen contraceptive pill such as Biphasil or Sequilar.Other hormone treatments include taking Androcur and Aldactone tablets which block the male-type hormones which women produce just before a period. These drugs have minimal side effects but do cause irregular periods, so should be combined with the pill or an oestrogen hormone.Many women are averse to taking hormone treatment for fear of gaining weight. Although the pill may cause slight fluid retention, significant weight gain will only occur if excessive calories are eaten. Many people blame the pill for poor eating habits, which are the real cause of weight gain. The other fear of hormone treatment is that it will lead to infertility later in life. Although the pill does suppress ovulation, this is only temporary and will not cause long-term problems.

This was the first disease to have its actual bacterial cause identified. The Norwegian, Dr G. Hansen, discovered the bacteria, known as Mycobacterium leprae, in Oslo in 1873. He tried unsuccessfully to infect human volunteers. Even today, it is extremely difficult to transmit this disease, and to date it has only been cultivated artificially in the foot pads of certain mice and in the South American armadillo.

To many people the mere mention of leprosy conjures up a picture of severely diseased and unclean people. Contrary to popular opinion, however, leprosy is not highly infectious. Most infections occur in childhood, but because of the long incubation period, from 2-10 years, it does not become apparent until adulthood. Furthermore, infections virtually only occur in endemic areas: that is to say, in countries or in races in which the resistance to this particular germ is, for some genetic reason, diminished. These countries include many parts of the Middle East, Asia, Africa. South America, Pacific areas, some Southern European countries around the Mediterranean, and Australia. The infection is transmitted by germs from the nose and throat, being inhaled or entering through a skin abrasion. The world incidence of this disease is between 12 and 20 million. In the United States there are 3000 known cases and about 10000 estimated cases. Similar discrepancies in numbers would also occur in other countries such as the United Kingdom or Australia. The reason for these discrepancies is that people with this disease do not want to come forward and be treated. This is because the disease and the term ‘leper’ have such unfortunate and incorrect connotations- People believe themselves to be outcasts and do not come forward for effective treatment. Australia, in fact, has the highest endemic rate of leprosy in the world because it is so prevalent amongst the Aboriginal people, particularly in the Northern Territory. The incidence in Australia has increased markedly over the past ten years due mainly to the increasing number of immigrants from India and South-East Asia.

From prehistoric times up until quite recent years, leprosy has been regarded more as a sin than as a disease. During the Dark and Middle Ages it was treated by priests, not doctors. Not only were a variety of common skin diseases incorrectly labelled as leprosy, but calling a person ‘a leper’, for doing anything undesirable, was a handy method of stigmatizing that person and making sure he or she become an outcast. Unfortunately, even today, people suffering from this disease are still discriminated against socially, legally, and medically, and are thus stigmatized by the community at large. Gradual education of the community and the substitution of the term Hansens disease for that of leprosy should, in time, change the public’s attitude towards the disease.

There are two major forms of Hansens disease. One, the tuberculoid form, appears in patients with relatively good resistance or immunity to the bacteria. Usually it occurs in localized areas, where it may be seen as a raised rash which has lost its sensibility to touch. There may also be loss of sensation in the area supplied by a specific nerve, and accompanying muscle weakness.

The other form, the lepromatous form, occurs in those with a poor resistance or immunity to the bacteria. It may first appear as a stuffiness of the nose, with or without a discharge, Then various rashes may appear which, in this form, are not insensitive to the touch. Later on lumps and bumps may appear, and there is often accompanying patchy hair loss. Later still the person’s features, particularly of the face, may become quite misshapen. This is due to damage of the underlying bone. The eyes may also be affected by various specific inflammations. Involvement of the nerves may lead to loss of sensation from the skin, and subsequent paralysis of muscles. Many organs in fact may be affected, but the patient docs not usually feel ill, nor does the disease often cause death. The onset of the condition is usually gradual, but when there is loss of sensation occurring in the hands or feet, repeated injury will result in considerable damage, thickening of the skin and subsequent deformity. It is this type of damage, due to anaesthesia, that may eventually result in fingers or toes disintegrating (this has been incorrectly called ‘fingers dropping off). It is also this thickening of the skin, along with the deformity caused by underlying bone damage, that can result in the disfigurements which have lead people to shun those suffering from the disease.



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