September - The Disease Most People Thought No longer Existed
Illustration by Cristina Daura as featured in the New York Times
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In 2019, Dr. Mark Hutchin was featured in the New York Times after one of his patients visited him for a 3rd opinion on a strange spot on his face that just wouldn’t go away. After seeing another local dermatologist and a plastic surgeon, the patient came to see Dr. Hutchin because he was frustrated about the weird spot and facial numbness he was experiencing without a firm diagnosis.
Here’s an excerpt from the article in New York Times featuring Dr. Hutchin called “A man discovers a disease most people thought no longer existed.”
“The patient made an appointment with Mark Hutchin, a young dermatologist he’d heard good things about. “I don’t know what this is, but I want it gone,” the patient told Hutchin. He went over the story of the sudden appearance of this strange spot and the weird numbness in that part of his face and the lower half of his ear. He hadn’t noticed anything else and generally felt healthy. But he didn’t like seeing that spot every time he looked in the mirror, and his wife was sure it was something bad.
Hutchin examined the man carefully. What about this little bump, here on your neck? he asked the man. Oh, that’s always been there, the patient told him. No, the doctor disagreed. I think this is new.
Before Hutchin started his training in dermatology, he spent two years in surgery, specializing in operations on the head and neck. His fingers recognized the bumpy linear structure he felt in the man’s neck as some kind of swelling of the great auricular nerve — the pipeline carrying sensory information from the ear and surrounding skin back to the spine. If the swelling compressed that nerve, that would explain why the man’s ear and face felt numb. The combination of this growth on the skin and the involvement of the nerve tissue suggested one disease in particular.
A Scary-Sounding Diagnosis
“Have you ever heard of Hansen’s disease?” Hutchin asked the patient. When the man shook his head, Hutchin explained that it was the polite name for an old disease — leprosy.”
“Have you ever heard of Hansen’s disease?” Hutchin asked the patient. When the man shook his head, Hutchin explained that it was the polite name for an old disease — leprosy. For the patient, the word immediately conjured ancient biblical images of sinners punished with this deforming disease. He pushed the images away. “Nobody gets leprosy anymore!” the man exclaimed.
It is a disease that has inspired revulsion for centuries. Those with visible evidence of the disease were often shunned and feared. It was thought to be both inherited and wildly contagious. We now know it is neither.
In the late 19th century, a Norwegian physician, Gerhard Armauer Hansen, identified the bacterium causing the disease, Mycobacterium leprae. It is a slow-growing cousin of Mycobacterium tuberculosis — the organism responsible for TB. M. leprae has an unusual need to reproduce in temperatures just below the average 98.6 of the healthy body, causing the organism to preferentially affect the skin of the face and the extremities — the coolest parts. The bacterium also prefers nerve tissue. Thus, the most recognizable characteristics of the disease historically have been numbness, loss of pigment and eventual loss of fingers, toes, ears, noses and eyes.
We now understand that Hansen’s is a disease easily fought off by a healthy immune system. Up to 90 percent of those infected with the bacterium will never come down with the illness. This man was at increased risk because his immune system was suppressed by the Humira he was taking for his psoriasis.”
