Leprosy mailing list – June 29th,
2006
Ref.:
Can leprosy skin lesions heal and disappear,
under treatment, in 3-6 months?
From: Ahmad L., Karachi, Pakistan
Dear
Dr Noto,
I refer to Dr felly Mukalay’s
message (LML June 22nd, 2006). Diagnosis of leprosy is often
not a problem for a clinician; hypo-pigmentation in brown skin is well
demarcated in TT to BT range of the spectrum (Jopling), a punch biopsy
for histopathology which shows a unique pattern of chronic
inflammatory cells should be considered as diagnostic. However in my opinion MDT
should be started if hypoesthesia / anaesthesia is accompanied.
Whether
leprosy lesions disappear (if it is not for a cosmetic reason) depends
on activity of the immune response.
Some lesions do disappear completely on 3-6 months of MDT and
others leave a scar which remain hypo / de-pigmented and
persistent hypoesthesia in the centre of the lesion. You may call it healing.
Prior
to MDT, when dapsone was used alone it was a policy of many
leprosy units to start with 25 mg weekly and increasing
25 mg weakly up to 350 mgs and stop all treatment as soon patient of
BT-BL range go in type 1 reaction and, to restart when it is over. Such insufficient doses have
caused dapsone resistance. Dapsone
as 100 mgs daily together with clofazimine for 5 years showed good
recovery and fewer reactions. Rifampicin
has further reduced this time period.
BUT I am afraid whether 450 - 600 mg monthly is sufficient
when in case of mycobacterium tuberculosis it is well tolerated on
daily dosage for 2 years. I
hate to see the dapsone story be repeated again.
Dr
Latif Ahmad
