Dans la lèpre, c’est la neuropathie périphérique qui est à l’origine des incapacités, des handicaps et du discrédit séculaire qui stigmatisent le lépreux. Cet article résume les récentes avancées concernant l’immunopathologie, l’épidémiologie et le traitement de la neuropathie hansénienne.

Leprosy is one of the six diseases that the WHO considers as the major threat in developing countries. Damage to nerves can occur before, during, and after treatment and can result in disabilities and long-term disfigurement, which is associated with stigma. Considered exotic and rare in European countries, it is important for neurologists to be able to make the diagnosis of leprosy early in order to rapidly alleviate patient suffering and prevent and reverse nerve damage. Leprosy must be considered in the differential diagnosis of peripheral neuropathy, even in the absence of skin lesions and especially when present in a patient from an endemic country. Immune response and mechanisms involved in nerve damage are not clearly understood. There is no predictive test for the extent of nerve damage and no good evidence on the best treatment.