Leprosy therapy and complications

MDT of leprosy

• PB – 6 months of monthly rifampicin and daily dapsone
• MB – 12 months of monthly rifampicin and daily dapsone and clofazimine

Drug Complications

• Rifampicin: urine discoloration, no prob with liver enzymes w monthly dose
• Dapsone: hemolytic anemia, skin reactions
• Clofazimine: Icthyosis, skin pigmentation
• 

Immunological complications

• Type 1: reversal reactions
  • BT, BB, BL are at risk in first six months of treatment
  • women at risk after childbirth
  • Increased cell-mediated immunity towards M. leprae
  • Skin
    • Increased erythema
    • Edema
    • New lesions
  • Nerves
    • Neuritis giving tender/painful nerves
    • Loss of sensation/strength
  • Treatment: prednisolone  40mg/day and taper over six months; continue close neurological assessment
• Type 2: erythema nodosum
  • At risk: LL 25-50%, BL 5-15%
  • Immune complex deposition, TNF production, T cell dysregulation
  • Sx: skin reactions, fever/malaise, arthritis, orchitis, neuritis, iritis
  • Management: mild prednisolone 20mg/day, mod-severe prednisolone 60-80mg/day or thalidomide; increase clofazimine
    • Control pain
    • Control acute neuritis
    • Control eye damage (atropine and steroid gtt)
    • Continue treatment and reassure patient