LEPROSY

Bambang Suhariyanto Lab/ SMF. I.K.Kulit & Kelamin FK. UNEJ/ RSUD. Dr.Soebandi Jember

G.N.A HANSEN (1873)

How to diagnose and treat leprosy?

How to examine for leprosy?

Examine in a well-lit room Examine the whole body Ask since when the patch was noticed Ask what treatments have been tried Test for sensation Look for any visible deformities

How to diagnose leprosy

Examine skin Check for patches Test for sensation Count the number of patches Look for damage

Signs of leprosy
Pale or slightly reddish patch Definite loss of sensation in the patch Signs of damage to nerves definite loss of sensation in hands/feet weakness of muscles of hands/feet/face visible deformity of

Leprosy patches...

. Can be pale, reddish or copper coloured . Lack sensation to pain, touch and heat

Leprosy patches ...

can be flat or raised do not itch

Check for loss of sensation

Take a pointed soft object (feather, cotton wick) Lightly touch alternately the patch and normal skin Ask the person to point where they were touched

What is not leprosy

Skin patches which have normal feeling are present from birth cause itching are white, black, dark red or silver coloured show scaling appear and disappear periodically spread quickly

Classification of leprosy

PB Skin Lesion Nerve Trunk Skin Smear 2 to 5 One Negative

MB >5 2 to 5 Negative or positive

Treating a patient with WHO MDT

Classification for treatment

Leprosy is diagnosed on finding a definite loss of sensation in one or more patches When you have examined the whole body, count the number of patches

1-5 patches is paucibacillary (PB) leprosy

More than 5 patches is multibacillary (MB) leprosy

Steps to start MDT

Classify as PB or MB leprosy Inform the patient about the disease Explain the MDT blister pack - show drugs to be taken once a month and every day Explain possible side effects (e.g. Darkening of skin) and possible complications and when they must return to the health centre Ask the patient when it is convenient for him/her to come back to the health centre. Give enough MDT blister packs to last until the next visit. Fill out the patient treatment card

Treatment regimens
PB Adult (Treatment: 6 blister packs) Rifampicin 600 mg once a month Dapsone 100 mg every day MB Adult (Treatment: 12 blister packs) Rifampicin 600 mg once a month Clofazimine 300 mg once a month Clofazimine 50 mg and dapsone 100 mg every day

MDT side-effects
Red coloured urine Darkening of skin Severe itching of skin

IDENTITAS PENDERITA
Nama No RM Jenis kelamin Umur Status Pekerjaan Tangga Alamat : Ny. S : 138471 : Perempuan : 35 tahun : Menikah : Ibu Rumah : Lumajang

RESUME
Px perempuan, 35 tahun dg keluhan sejak 1 th yll muncul bercak kemerahan di pipi kiri salep oleh mantri tidak berkurang/menghilang, hanya warnanya menjadi tdk begitu merah. Karena tdk ada keluhan lainnya, maka bercak tersebut dibiarkan saja. Beberapa bln kemudian, muncul bercak2 di kaki dg ukuran yg lebih kecil dbd bercak di wajah, tidak gatal dan tidak nyeri berobat ke Puskesmas dan dikatakan alergi. 5 bln kemudian muncul bercak lagi di tangan dan di dada, tidak gatal, tidak nyeri. 3 bln kemudian px merasa tangannya bengkak dan saat dicubit sering tdk terasa sakit. Namun hal ini dibiarkan saja. Px merasa badannya terus lemah dan sering gringgingan terutama di kaki dan tangan.

Bbrp mgg yll px merasa alisnya lebih tipis dari biasanya, bentuk hidungnya berubah berobat ke RS dr. Soebandi. Sebelumnya tdk pernah menderita penyakit spt ini. Namun px mengatakan pernah kontak dg px kusta (tetangga dekat), 10 th yll. Kontak selama > 5 th. Pmx fisik lesi: > 5, efluoresensi: macula hiperpigmentasi, hipoanestesi, ukuran lentikulernumuler, bulat - lonjong, batas tegas, simetris bilateral, pinggir eritematous, terdistribusi scr general di regio fasialis didapatkan pula nodul simetris pd regio torakal dan ekstremitas superior dan inferior. Madarosis (+), saddle nose (+) dan fascies leonina (+) serta infiltrasi di kedua lobulus auricula. Pada pmx saraf: penebalan N. Auricularis Magnus D/S, g3 sensasi raba didalam dan luar lesi, g3 sensasi nyeri di dalam lesi. Kulit terlihat iktiosis dan oedema di keempat ekstremitas. Kekuatan motoris sedang. Pemeriksaan lab: BI +3 dan MI 70%.

DIAGNOSIS BANDING 1. Drug Eruption 2. Dermatitis Alergica DIAGNOSIS KERJA Kusta Tipe Multi basiler (LL)

PLANNING
1. Medikamentosa (MDT-MB 12-18 bln) Sebulan sekali di bawah pengawasan # Rifampisin : 2 x 300 mg # Lamprene : 3 x 100 mg # DDS : 1 x 100 mg -Hari ke2 - 28 # Lamprene : 1 x
2. KIE -Penyakit ini dpd disembuhkan, ttp pengobatan lama (11,5 th), tidak boleh putus obat. -Jika dalam masa pengobatan, tiba-tiba badan px demam, nyeri seluruh tubuh, disaertai bercak2 memerah, mencari pertolongan medis. - Penyakit ini mengganggu saraf mungkin terjadi kecacatan jika tdk ada tindakan pencegahan. Pencegahan dilakukan pada jari-jari tangan dan kaki yang kaku

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