Leprosy Mailing List – September 29th, 2007
Ref.: Dapsone
hypersensitivity syndrome
From: Saunderson P., Greenville, SC, USA
Dear Salvatore,
I would like to echo what has been reported by
Richard de Soldenhoff (LML September 27th, 2007),
concerning dapsone hypersensitivity syndrome, which I think is an
important issue. Perhaps I may make a few additional points?
Firstly, the incidence
and mortality related to dapsone hypersensitivity do seem to vary
between countries: I worked for many years in leprosy control in East
Africa and I don’t remember any deaths from this cause. However,
the issue was discussed at the recent Anandaban Anniversary Symposium
in Katmandu, Nepal, where a number of deaths have been reported in
relation to dapsone hypersensitivity, in recent years. A paper
has recently been published in Tropical Doctor: Mortality due to dapsone
hypersensitivity syndrome complicating multi-drug therapy for leprosy
in Nepal. B
Pandey et al. TROPICAL DOCTOR 2007; 37: 162–163.
Secondly, MDT was originally designed in 1981
with high rates of dapsone resistance in mind, so it had to be an
effective regimen in the face of an inactive dapsone component. In
individual cases, therefore it is not unreasonable to give MDT with
the dapsone removed, without any additional drugs. If a national
program feels it is appropriate to remove dapsone completely for all
patients in the country, the alternatives that Richard de Soldenhoff
suggests should be considered.
It seems to me that a significant mortality
caused by a redundant drug in the treatment of a non-fatal disease, is
unacceptable.
Paul
Dr
Paul Saunderson, MD, MRCP
Medical Director: American Leprosy
Missions
Head Office: 1 ALM Way, Greenville, SC
29601, USA
Home address: Østrem, 6013 Ålesund,
Norway
Email: psaunderson@leprosy.org
