MANAGEMENT OF

LEPROSY
 Overview
• Anti microbial therapy of leprosy
• Therapy for lepra reactions
• Treatment of other complications
• Prevention and control of leprosy
 History a Glance
• Chaulmoogra oil in Indian
medicine
• 1930’s antimicrobial property of
dyes Domark
• 1940’s Dapsone
• 1981 WHO Multidrug therapy
 Drugs Used
• Dapsone
• Clofazimine
• Rifampin
• Ofloxacin; minocycline;
clarithromycin
 DAPSONE
• Bacteriostatic sulpha drug
• MOA
• A/R –Hemolytic anemia,
–cutaneous,
–lepra reaction
–general
• Status
 MULTIDRUG THERAPY
MB MDT
• Duration of treatment: 1
year (previously 2 years)
• Rifampicin: 600mg
monthly
• Clofazimine: 300mg
monthly and 50mg daily
• Dapsone: 100mg daily
 PB MDT
Duration of treatment: 6 months
• Rifampicin: 600mg monthly
• Dapsone: 100mg daily
 PBSL MDT (ROM REGIME)
• Single lesion paucibacillary
leprosy (adults)
• Single dose of:
• Rifampicin: 600mg
• Ofloxacin: 400mg
• Minocycline: 100mg
 Steps in MDT
• 1)Classify the lesion*
• 2)Inform the patient*
• 3)Explain the MDT blister pack*
• 4)Show drugs to be taken once a month and
every day
• 5)Explain possible side effects and
complications*
6)Give enough MDT blister packs to last
until the next visit.
• 7)Fill out the patient treatment card .
 1)Treatment Classification
• CLINICAL
• The diagnosis is made based on finding
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), more than 5
patches is multibacillary (MB) leprosy

• HISTOLOGY
• Result- MB ; PB ; SLPB
 2)Inform the patient about the
disease

• Caused by a bacteria
• Affects skin and sometimes nerves
• Progresses slowly
• Easy to diagnose and cure
• Lead normal life, do not change life
style
2)Information To Patients About
The Treatment

• MDT will cure you completely

• MDT is free of cost
• MDT is available in all health centres
• MDT should be taken as advised
(regular, full course)
• If you have problem or questions
contact your health centre
3)Explain the MDT blister pack
 5) Possible side effects

• Brown black skin discolouration

• Xerosis
• Adverse Rxns to Dapsone
• Hepatotoxicity
 Complications
• Resistance
• Relapse - Histoid Nodules
• Lepra Reaction ENL
 Treatment Of Lepra Rxns
• Type 1
– Glucocorticoids 40-60mg daily, 3 months
(Only in severe Rxns)
Thalidomide 200-300mg
Type 2
Glucocorticoids 40-60mg daily, 1-2
weeks
Thalidomide 100-300mg OD (persistant
infection)
Clofazimine 300mg OD
 Treatment of other
complications
• Plantar Ulcerations
• Nasal defects – Saline nasal drops
• Eye – Drops nightly, Oinment during
day
• Impotence – Testosterone.
• Nerve Abcess – Surgical
Decompression
 Prevention and control of
leprosy

• VACCINATION
BCG, Leprae protein

• CHEMOPROPHYLAXIS
Dapsone (only in Tuberculoid)
• National Leprosy Control Programme
had been in operation since 1955.

• The objective of the programme is to

achieve reduction in the case load to 1 or
less/10,000 population
Programme Strategies:
• (i) Provide domiciliary treatment
(MDT) in endemic districts
• (ii) Provide services through mobile
leprosy treatment in moderate and
low endemic districts.
• (iii) Organise health education to
patients, their families and the
community to increase- awareness
and to remove stigma.
• (iv) To provide deformity and ulcer
care and medical rehabilitation
services to the needy patients
THANK YOU