Leprosy (Hansen's disease) in South Dakota.

Worldwide Hansen's disease is an important and relatively common disease, but is still very rare in South Dakota. Two patients are described to help demonstrate the wide variety of clinical manifestations associated with Hansen's disease. Since the clinical appearance of Hansen's disease is highly variable, the following six forms of Hansen's disease are described: Indeterminate, tuberculoid (TT), borderline tuberculoid (BT), borderline (BB), borderline lepromatous (BL), and lepromatous leprosy (LL). In addition, three well-recognized reactional forms of leprosy are also described: Type 1 (lepra reaction), type 2 (erythema nodosum leprosum), and type 3 (Lucio's phenomenon). While the disease affects primarily the skin and nerves, health care providers of all disciplines should remain alert for this disease which can present with a high degree of clinical variability.