Marked by stigma, inked by belief: tattooing in leprosy–a community perspective

Introduction: Leprosy remains a public health challenge in India, not only for medical reasons but also due to persistent stigma and deeply ingrained cultural beliefs that influence behavior when seeking medical care. This case report describes a 28-year-old woman with borderline tuberculoid leprosy who delayed seeking medical care due to cultural beliefs.

Outcome: After eight months without medical attention, the patient presented with a well-defined, hypopigmented, hypoesthetic lesion above her right knee, accompanied by thickening of the right peroneal nerve. Two intersecting tattoo lines, applied by a traditional healer in an attempt to control the disease, were visible over the lesion. Histopathology confirmed the diagnosis of borderline tuberculoid leprosy, and high-resolution ultrasound confirmed peripheral nerve involvement. The patient was subsequently treated for six months with paucibacillary multi-drug therapy and received comprehensive disease management counseling.

Discussion: This case demonstrates how cultural practices can hinder early diagnosis and effective treatment. Culturally sensitive health education is essential to combat stigma and improve leprosy control.