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Treatment and Management of Leprosy

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HealthWiki > Disabled Village Children > Chapter 26: Leprosy: Hansen’s Disease > Treatment and Management of Leprosy


Treatment and management of leprosy should include 4 areas:

  1. Long-term medical treatment to control the leprosy infection should begin as early as possible.
  2. Emergency treatment when necessary to control and prevent further damage from leprosy reactions.
  3. Safety measures, aids, exercises, and education to prevent deformities (sores, burns, injuries, contractures).
  4. 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.

Medical Treatment

Multi-drug treatment (MDT) consisting of rifampicin and dapsone, is now recommended by the World Health Organization. These medicines should be used in combination, not alone. MDT is usually supplied free. Another medicine may be added to the treatment if the patient is a child or an adult, or if the patient has PB or MB leprosy.

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 reduces cost and side effects.

Clofazimine treatment is added to fight MB leprosy and the Type 2 reaction.

A combination therapy is used to fight shingles 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.

Medicine for PB leprosy
(Treatment is for 6 months.)
children under 10 years children
10 to 14
years
adults
monthly dose rifampicin 300 mg 450 mg 600 mg Take the monthly dose on the first day of treatment (day 1) and then every 28 days for 6 months. Take the daily dose every day for 6 months. Treatment must be completed within 9 months.
monthly dose dapsone 25 mg 50 mg 100 mg
daily dose dapsone 25 mg 50 mg 100 mg
Medicine for MB leprosy
(Treatment is for 6 months.)
children under 10 years children
10 to 14
years
adults
monthly dose rifampicin 300 mg 450 mg 600 mg Take the monthly dose on the first day of treatment (day 1) and then every 28 days for 12 months. Take the daily dose every day, or as noted, for 12 months. Treatment must be completed within 18 months.
monthly dose clofazimine 100 mg 150 mg 300 mg
monthly dose dapsone 25 mg 50 mg 100 mg
daily dose dapsone 25 mg 50 mg 100 mg
daily dose clofazimine 50 mg twice a week 50 mg every other day 50 mg

Check with your Ministry of Health and WHO for information about leprosy treatment.

Importance of long-term treatment

Treatment to cure leprosy takes a long time: 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, not only can leprosy return, but a sometimes a leprosy reaction may result which can cause even more nerve damage and paralysis or blindness.

It is therefore essential that health and rehabilitation workers make sure the person with 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 Chapter 26, feeling loss, paralysis, and deformities need not happen to a person with leprosy. Early diagnosis and treatment together with quick care of leprosy reactions should prevent the development of many deformities.

Care of a leprosy reaction has 4 objectives:

  • Prevent nerve damage that causes loss of feeling, paralysis, and contractures.
  • Stop eye damage and prevent blindness.
  • Control pain.
  • Continue with medicine to kill leprosy bacilli and prevent the disease from getting worse.


Care includes:

  1. 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) may be needed. Because this is a medical emergency and because corticosteroids are dangerous and often misused medicines, if at all possible get experienced medical advice before using them.
  2. 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 200 mg. daily in adults) and later reduced as the reaction lessens. However, for severe reactions that damage nerves, prednisolone is needed.
  3. 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 hand with a splint attached with the hand in the shape of a C
    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 blindness. 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 do not blink normally
A face with one eyelid close and the other open
leads to
eye irritation and infection
a face with an irritated eye
leads to
scarring and blindness
An eye with scarring covering most of the pupil
Hands do not feel; skin dry; weakness of fingers and thumb
A weak trembling hand reaching
leads to
stiffness and contractures of fingers and thumbs; loss of bone
DVC Ch26 Page 222-6.png
DVC Ch26 Page 222-5.png
leads to
also burns and injuries
Feet do not feel; skin dry; drop foot painless sores and injuries; stiffness and contractures; loss of bone
DVC Ch26 Page 222-7.png
leads to
DVC Ch26 Page 222-8.png
DVC Ch26 Page 222-9.png
skin cracks
leads to
a normal foot and a foot with less bone
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 normal 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.
 a blister on the sole of the foot
A burst blister in the sole of the foot
a burst blister infection going into the bone in the sole of the foot
a deformed stump like foot


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.



This page was updated:21 Nov 2019