Trigeminal trophic syndrome: Analysis of the number of peripheral nerve fibres and blood vessels in the lesional skin

examination requires the patient undergo a general skin examination by a non-skin specialist. No currently available laboratory tests adequately detect leprosy. It is most likely that this patient contracted the disease during his most recent visit to Nepal and then re-entered Australia, evading early detection; no doubt aided by the often subtle manifestations of the tuberculoid variant. There have been a few reported leprosy cases in nonmigrants who have not travelled, but these have predominantly been in Indigenous Australians. There is a real human cost of not detecting this disease. Not only does the patient experience disruptions to work and travel plans, but all close contacts require periodic health assessment for at least 5 years. It is fortunate that this patient had the tuberculoid variant, as his transmission risk was comparatively less. In all, 190 000 people immigrated to Australia from 2014 to 2015, representing a fourfold increase from 1984 to 1985, with most originating from leprosy-endemic India. There were 36 notified cases of leprosy in the last 3 years as opposed to 27 in the previous four, representing a 33% increase. We propose that the immigration department consider specific leprosy questioning and the examination of uncertain skin rashes by a skin specialist, especially for immigrants from endemic countries.