Although leprosy is increasing in incidence in the United States, it is confined almost entirely to immigrants from developing countries and their close contacts. While the clinical disease has not changed, leprosy has diffused more widely throughout the United States as a result of migration. Primary care physicians should maintain a high index of suspicion in foreign-born individuals with skin or peripheral nerve problems. Punch biopsy of skin lesions is the most practical diagnostic method for both the multibacillary and paucibacillary types of leprosy. Because of resistance to dapsone, multi-drug treatment is now the rule; most patients are referred to or managed in consultation with a regional Hansen's disease clinic for long-term treatment. Consultation is available to any physician through the National Hansen's Disease Center in Carville, Louisiana.
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