Treatment

          Today, a multi-drug approach is utilized to treat leprosy, with a high success rate for cure. However, patient compliance is essential, and treatment can be extremely long; 12-24 months. (In 1997, the World Health Organization reduced the duration of therapy for multibacillary leprosy to 12 months; however, in the United States, treatment continues to be done for 24 months for severe cases.)To date, there have been no reports of anti-microbial resistance to multi-drug therapy (MDT), much to the relief of the World Health Organization (WHO). The WHO provides MDT in blister packs, freely available throughout the world, thanks in part to partnerships with pharmaceutical companies like Novartis. The blister packs provide an easy to transport and use format for the patient.

 

 

Right : Different blister packs are given to different types of leprosy patients. For less severe paucibacillary patients, only two antibiotics are used. For the more serious multibacillary patient, a three antibiotics are used as part of the treatment regimen.

Photo Credit: World Health Organization

 

 

 

Specific Drug Information

Note: The following information does not replace the advice of your medical doctor.

 

Dapsone

(4,4’diaminodiphenysulfone, DDS)

 

Created in the early 20th century by German chemists, this drug was only utilized in the fight against leprosy in the late 1940s. A popular leprosy drug due to its efficaciousness and inexpensive cost, clinicians quickly became concerned about its use when used alone. Since the 1980s, the World Health Organization has recommended that Dapsone must be used in conjunction with other antibiotics.

 

Mode of action: Appears to be a competitive inhibitor preventing the synthesis of dihydropfolic acid (Jacobson 196).

 

Side effects: In particular, “DDS/Sulfone syndrome” is well documented, starting 6 weeks after dapsone treatment begins. Severe symptoms include exfoliative dermatitis and hepatitis.

 

Rifampin

(Also known as: rifampicin)

 

One of the second-generation leprosy drugs discovered after Dapsone, monotherapy (i.e. using the antibiotic alone) with this drug can also lead to antibiotic resistance. Most clinicians feel that rifampin should be administered under supervision, to ensure proper compliance in addition to the monitoring of toxic side effects. Rigampin’s bactericidal activity is the most rapid of the three listed here.

 

Mode of action: Interferes with bacterial RNA synthesis (Jacobson 199).

 

Side effects: Most commonly, hepatotoxicity (toxicity in the liver); “flu like” symptoms.

 

Clofazimine

(Also known as Lamprene)

 

Initially developed as a drug for tuberculosis, it became an accepted agent for MDT therapy for the multibacillary leprosy patient.  Resistance to the drug during monotherapy is possible (Jacobson 201).

 

Mode of action: Binds to the DNA of the leprosy bacterium (Gladwin 136).

 

Side effects: Discoloration of the skin into a reddish/purplish-black skin tone but usually clears several months after treatment is stopped. Discoloration is expected during treatment of active disease (Jacobson 201). Gastrointestinal complaints have also been noted.

 

Leprosy Reactions

 

Hypersensitivity to the dying or dead leprosy bacteria can result in marked reactions that may complicate MDT therapy. MDT therapy should not be stopped despite the reactions. Instead, these reactions should be treated with corticosteroids (e.g. prednisone), which reduces the body’s hypersensitivity.

 

A Type 1 Reaction, or reversal reaction, occurs within 1 year of treatment; symptoms include a marked swelling of lesions as well as possible nerve function loss.

 

A Type 2 Reaction, or Erythema Nodosum Leprosum, is associated with an outbreak of a painful, nodular rash. The highly publicized drug, thalidomide, known for causing birth defects, has been advocated for the treatment of this reaction.

 

Preventive Therapy

 

The patient must also engage in protective measures to prevent inadvertent injury, trauma or infection in areas with anesthesia. Close monitoring of limbs, good hygiene and the use of protective eyewear and eye-drops can significantly prevent the morbidity associated with leprosy.

 

 

Reconstructive Surgery

 

The cosmetic effects of leprosy can be devastating. As noted by the earliest clinicians, leprosy can turn a young man into having an appearance of “an evil wrinkled old man” (Richards 105). While physical therapy and special apparatus can be applied to the patient’s limbs to help with the “clawing” of hands and feet, reconstructive surgery can result in a marked improvement in quality of life and social acceptance. Grafts for eyebrows, nasal reconstruction and face-lifts can reduce the patient’s saddle-nose deformity or lion-like appearance. Peace of mind through the therapy can be most helpful for the patient’s recovery (Brand).

 

 

Right : Before and After picture of a leprosy patient who underwent nasal reconstruction, and eye-brow graft and face-lift.

Photo Credit: Paul W. Brand. Rehabilitation in Leprosy. Leprosy. 1983