The three cardinal signs of leprosy are:

• skin patch with loss of sensation
• one or more enlarged peripheral nerves
• the presence of leprosy bacilli

History taking

Proper history taking and collection of certain information on the patient are very important for understanding the patient's situation and for tracing a lost patient. The following must be obtained:

• general information: all three names, sex, year of birth, full address from home to clinic, occupation

• contact information: other leprosy cases in the patient's household

• main complaints, including date of onset, site of first lesions, subsequent changes and development received.

Physical examination

Physical examination should always be carried out with adequate light available and with enough privacy for the person to feel at ease.

The patient is asked to undress. To ensure that no important sign is missed, a patient must be examined systematically. A well tried system is to examine the patient as follows:

• start with examination of the skin; first head, then neck, shoulders, arms, trunk, buttocks and legs

• then palpation of the nerves; starting with the head and gradually going to the feet

• then the examination of other organs

• examination of the skin smear

• finally the examination of eyes, hands and feet for disabilities.

Complications due to nerve damage

Patients should be examined for the following complications which result from nerve damage:

• injury to cornea and loss of vision due to incomplete blink and/or eye closure
• skin cracks and wounds on palms and soles with sensation loss
• clawed fingers and toes
• dropfoot
• wrist drop
• shortening and scarring in fingers and toes with sensation loss.

Mark and draw also wounds, clawing and absorption levels on the maps using the appropriate marks.

Disability grading

At the time of diagnosis the condition of all nerves, eyes, hands and feet should be recorded accurately on the Patient Record Card, including the disability grading. Disabilities should be graded as follows: