Hesperian Health Guides
Treatment and Management of Leprosy
HealthWiki > Disabled Village Children > Chapter 26: Leprosy: Hansen’s Disease > Treatment and Management of Leprosy
- Multidrug therapy to treat the leprosy infection should begin as early as possible.
- Emergency treatment when necessary to treat and prevent further damage from leprosy reactions.
- Safety measures, aids, exercises, and education to prevent deformities (sores, burns, injuries, contractures).
- Social rehabilitation: Work with the individual, parents, schools, and the community to create a better understanding of leprosy, to lessen people’s fears, and to increase acceptance, so the child or adult with leprosy can lead a full, happy, meaningful life.
Contents
Medical Treatment
Multi-drug treatment (MDT) consisting of rifampicin (rifampin), dapsone, and clofazimine is now recommended by the World Health Organization. These medicines should be used in combination, not alone. MDT is usually supplied free.
For years, dapsone was the main drug used. Unfortunately, in some areas the leprosy bacilli became ‘resistant’ to dapsone (the leprosy was not cured by it).
Rifampicin works much faster against leprosy. To prevent development of resistance, it is given in combination with other anti-leprosy medicines. Rifampicin needs to be given only once a month. This kills bacteria quickly. Treatment with rifampicin is less expensive and does not have many side effects.
Clofazimine treatment is added to fight MB leprosy and the Type 2 reaction.
A combination therapy is used to treat single lesions in PB leprosy. It contains: 600 mg rifampicin, 400 mg ofloxacin, and 100 mg minocycline. It is taken by mouth one time only. A children’s dose is one-half the adult dose.
| Age | Medicine | How to take | Duration MB |
PB |
| children under 10 years | rifampicin | 10 mg/kg by mouth once a month | 12 months | 6 months |
| clofazamine | 100 mg by mouth once a month, and 50 mg by mouth 2 times a week | |||
| dapsone | 2 mg/kg by mouth once a day | |||
| children 10-14 years | rifampicin | 450 mg by mouth once a month | 12 months | 6 months |
| clofazamine | 150 mg by mouth once a month,and 50 mg by mouth every other day | |||
| dapsone | 50 mg by mouth once a day | |||
| children 15 and older and adults | rifampicin | 600 mg by mouth once a month | 12 months | 6 months |
| clofazamine | 300 mg by mouth once a month, and 50 mg by mouth every other day | |||
| dapsone | 100 mg by mouth once a day | |||
| Take rifampicin on an empty stomach to improve the body’s absorption of the drug. Check with your Ministry of Health and WHO for local information about leprosy treatment. | ||||
Importance of regular treatment
Treatment to cure leprosy takes from 6 months to 1 year or more depending on the type of leprosy. If treatment is stopped too soon or if the medicine is not taken at the right time and regularly, not only can leprosy return, but sometimes a leprosy reaction may result which can cause even more nerve damage and paralysis or loss of vision.
It is therefore essential that health and rehabilitation workers make sure the person affected by leprosy and her family understand the importance of taking the medicine regularly. It is helpful if a health worker can be present when the child’s monthly dose is taken. This way, he can check her for any complications of leprosy.
TREATED EARLY, LEPROSY NEED NOT BE A DEFORMING OR DISABLING DISEASE.
Treatment of leprosy reactions
As we mentioned in at the beginning of this chapter, loss of feeling, paralysis, and deformities need not happen to a person with leprosy. Early diagnosis and treatment together with quick care of leprosy reactions prevents the development of many deformities.
Care of a leprosy reaction has several objectives:
- Prevent nerve damage that causes loss of feeling, paralysis, and contractures.
- Stop eye damage and prevent loss of vision.
- Control pain.
- Continue with medicine to kill leprosy bacilli and prevent the disease from getting worse.
- Improve general health and participation in activities of daily life.
Care includes:
-
Medicine to reduce pain and inflammation
For mild reactions (skin inflammation but not pain or tenderness of nerves) use aspirin or ibuprofen. See dosage and precautions.For severe reactions (pain along nerves, increasing tingling, numbness or weakness, eye irritation, or painful testicles) corticosteroids (prednisolone) are needed. Because this is a medical emergency and because corticosteroids are dangerous, if at all possible get experienced medical advice before using them.
- Anti-leprosy medicine should be continued throughout the leprosy reaction.
Clofazimine helps to reduce Type 2 reactions and fights the leprosy. The dose of clofazimine can often be increased (to 300 mg. daily in adults) and later reduced as the reaction lessens. However, for severe reactions that damage nerves, prednisolone is needed.
- Splinting and exercise
Holding the affected limbs in splints during a severe reaction helps reduce pain and prevent nerve damage and contractures (see Chapter 8.)
A good splint for the hand—to avoid contractures and maintain a useful position.Joints should be splinted in the most useful position. Splints can be made of plaster bandage or molded plastic. Very carefully pad splints for hands or feet that do not feel pain.Leave the splint on day and night until pain and inflammation are gone. Remove only for gentle range-of-motion exercise at least once a day.
Cause of deformities
When most people think of leprosy, they think of the severe deformities of the advanced case: deep open sores (ulcers), clawed fingers, gradual loss of fingers and toes, and eye damage leading to loss of vision. Actually, these deformities are not caused directly by leprosy germs, but result from damaged nerves. Nerve damage causes 3 levels of problems, one leading to the next:
| LEVEL 1: loss of feeling, of sweating, and of strength in certain muscles | LEVEL 2: injuries, joint stiffness | LEVEL 3: progressive deep infections with bone destruction and loss of vision | |||
| Eyes cannot close, do not blink as usual |
 leads to |
eye irritation and infection |
 leads to |
scarring and and loss of vision |  |
| Hands do not feel; skin dry; weakness of fingers and thumb |
 leads to |
stiffness and contractures of fingers and thumbs; also burns and injuries | loss of bone |  | |
 leads to
| |||||
| Feet do not feel; skin dry; | painless sores and injuries; | stiffness and contractures; | loss of bone | ||
 drop foot
leads to |
 |
 skin cracks
leads to |
 | ||
| often PREVENTABLE with medical treatment of leprosy before there is nerve damage | often PREVENTABLE with protective eye and skin care and exercise to keep full movement of joints | often PREVENTABLE with careful early treatment of sores, burns, and infections | |||
When there are level 1 problems, there is a lifelong danger of level 2 and 3 problems. Because feeling has been lost, the person no longer protects herself automatically against cuts, sores, thorns, and other injuries. And because they do not hurt, these injuries are often neglected.
For example, if a person with without loss of feeling walks a long way and gets a blister, it hurts, so he stops walking or limps.
| But when a person with leprosy gets a blister, it does not hurt. | So he keeps walking until the blister bursts and becomes infected. | Still without pain, the infection gets deeper and attacks the bone. | In time the bone is destroyed and the foot becomes more and more deformed. |
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Usually, leprosy bacilli cannot be found in these open sores. This is because the sores are not caused by the bacilli. Instead, they are caused by pressure, injury, and secondary infection.