2. Leprosy
• Leprosy is a chronic, progressive bacterial infection caused by the
bacterium Mycobacterium leprae. It primarily affects the nerves of
the extremities, the skin, the lining of the nose, and the upper
respiratory tract. Leprosy is also known as Hansen’s disease.
• Leprosy produces skin ulcers, nerve damage, and muscle weakness. If
it isn’t treated, it can cause severe disfigurement and significant
disability
• Common symptoms: muscle weakness, numbness in
the hands, arms, feet, and legs, skin lesions
3. • The skin lesions result in decreased sensation to touch, temperature,
or pain. They don’t heal, even after several weeks. They’re lighter
than your normal skin tone or they may be reddened from
inflammation.
• Leprosy has been considered incurable since ages and bears a social
stigma.
• Due to availability of effective antileprotic drugs now, it is entirely
curable, but deformities/defects already incurred may not reverse.
4. Types
• Types
1. Paucibacillary leprosy (PBL) Patient has few bacilli and is noninfectious.
• Single lesion paucibacillary leprosy (SL PB):With a solitary cutaneous lesion.
• Paucibacillary leprosy (PB): With 2–5 skin lesions. Both SLPB and PB cases are
skin smear negative for M.leprae.
2. Multibacillary leprosy (MBL) Patient has large bacillary load and is infectious.
• With > 6 skin lesions, as well as all smear positive cases.
9. Dapsone
• It is di-amino diphenyl sulphone (DDS)
• Structurally related to sulphonamoide
• Bacteriostatic in nature at low concentration
• Simplest, Oldest. Cheapest, Most active and Most commonly
indicated drug in Leprosy
10. Mechanism of Action
• Chemically related to Sulphonamide, so mechanism of action is
similar to sulphonamide
• It has antimetabolite action
• It inhibits the action of PABA and blocks the folic acid synthesis in
bacteria.
11. Indication
• Leprosy(In combination with other anti-leprotic drug)
• Chloroquine resistance Malaria(With pyrimethamine)
• Pneumocystis pneumonia in HIV patients
• Nodular acne vulgaris
• Toxoplasmosis
12. Adverse effects
• Mild haemolytic anaemia is common.
• Gastric intolerance—nausea and anorexia are frequent in the beginning,
decrease later.
• Sulfone syndrome*
• Methaemoglobinaemia
• Headache and Anorexia
• Paresthesias
• mental symptoms
• drug fever.
• Cutaneous allergic reactions
• Hepatitis and agranulocytosis are rare complictions.
13. Contraindication and Precautions
• Hypersensitivity reactions
• Severe Anemia
• Precaution should be taken in
• Patient with liver dysfunction and G6PD deficiency
• Monitor hemoglobin level at regular interval
• Pregnancy and lactation
14. Drug interaction
• Rifampin lowers dapsone levels 7 to 10-fold by accelerating plasma
clearance.
• Folic acid antagonists such as pyrimethamine may increase the
chance hematologic reactions.
17. Introduction
• It is a dye with leprostatic action
• anti-inflammatory properties(it is valuable in lepra reaction.)
• Weak bactericidal against M.leprae.
• Used in combination with Dapsone and Rifampin in Multi Drug
Therapy treatment in Leprosy
18. Mechanism of action
• The putative mechanisms of anti-leprotic action of clofazimine are:
• Interference with template function of DNA in M.leprae
• Alteration of membrane stucture and it stransport function.
• Disruption of mitochondrial electron transport chain
19. Indication
• Leprosy (In Dapsone allergy and resistant case), component of
multidrug therapy (MDT) of leprosy.
• In leprae-reaction , Because of its antiinflammatory property
• MDT for M.avium Comples infection.
20. Adverse drug reactions
• reddish-black discolouration of skin, especially on exposed parts.
• Discolouration of hair and body secretions
• Dryness of skin and itchy skin
• oAcneform eruptions and
• phototoxicity
• Conjunctival pigmentation
• Nausea, anorexia, abdominal pain
• weight loss and enteritis
• loose stools can occur
irritant effect
of the drug—subsides
with dose adjustment
and
by taking the drug with
meals.
21. Contraindication and Precautions
• Hypersensitivity patient
• First trimester of Pregnancy
• Patient with hepatic and liver disease
• Lactation
• Precaution should be taken in patient with
• Gastrointestinal disease
• Later stages of pregnancy
22. Drug interaction
• The metabolism of Dapsone can be decreased when combined
with Clofazimine.
• The serum concentration of Daptomycin can be increased when it is
combined with Clofazimine.
24. Treatment of Leprosy
• The objective of Chemotherapy in Leprosy are
• To control Leprae reaction
• To make the patient non-infective(Bacteria incapable of multiplication)
• To allow the body to clear bacilli
26. • Alternative therapy for Paucibacillary leprosy with few bacteria and
single skin lesion :
• Single dose of Rifampicin 600 mg ,Ofloxacin 400 mg,Minocycline 10 mg
• Tuberculoid,borderline and intermediate:
• Dapsone 100 mg OD orally and Rifampicin 600 mg once a month for at least 6
months
• Lepromatous disease:
• Dapsone 100 mg OD and Rifampicin 450-600 mg OD orally
• Dapsone 100 mg OD orally and Clofazimine 300 mg once a month for 1-5 years
Editor's Notes
It is the reaction which develops 4–6 weeks after starting dapsonetreatment: consists of fever, malaise, lymph nodeenlargement, desquamation of skin, jaundice and
anaemia. It is generally seen in malnourished patients, and has become more frequent after the introduction of MDT. Some or all of the abovesymptoms may occur. Its treatment consists of stopping dapsone and instituting corticosteroid therapy along with supportive measures.
