Leprosy Mailing List
– December 2nd, 2007
Ref.:
Dapsone
From:
Ahmad L., Karachi, Pakistan
Dear Dr Salvatore,
I have been following closely the dapsone debate in
various LMLs. I have
accompanied dapsone since it was used as mono therapy. This controversy is not new. After a decade long isolation
in shelf when dapsone was used as an anti-leprosy drug, some orthodox
missionaries who believed in spiritual cure blamed dapsone for all
untoward effects like reactions, deformities, anaemia etc.
I would agree with Prof Ryan (LML October 14th,
2007) when he mentioned that we should re-consider before throwing it
out. The so-called
dapsone hypersensitivity syndrome mentioned in Dr de Soldenhoff's LML
(September 27th 2007) form Indonesia has perhaps been
over-reported as Dr Saunderson said in his LML (29th September
2007).
In Karachi I have worked for about 2 decades in a
100-bedded referral leprosy hospital and I can count number of
exfoliated dermatitis on my fingertips.
Less so is acute haemolytic crisis in G6PD deficiency. I have also noticed low
haemoglobin levels after starting dapsone. This may be due to sub
clinical haemolysis. The
other contributing factors to anaemia may be due to poor nutritional
state of leprosy patients, or anorexia secondary to drug addiction
(cannabis) which was estimated at one time about 60 % of admitted
patients.
Apart from its drawbacks mentioned above plus emergence
of drug resistance (both secondary and primary) dapsone has many
advantages. It is very
cheap, it is well absorbed from gut, it is widely distributed in body
fluids and tissues, its half life is 1-2 days, its concentration in
leprosy affected skin is several times higher and it is well tolerated
in a dose of 100 mg daily (at least in Karachi where multi ethnic
society exists). It is
also been used in other diseases like Pneumocystic pneumonia in AIDS,
Dermatitis Herpetiformis, Pemphigus and Pemphigoid, Bullous Lupus
Erythematosus.
If global figures show decline in spread of leprosy, it
would be unwise to dismember dapsone from MDT unless / otherwise a
strong anti-leprosy bactericidal drug like rifampicin is invented and
introduced in MDT.
With best regards,
Dr Latif Ahmad.
