Classification of Leprosy Disease | Treatment of Leprosy Disease

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Leprosy Disease:

Leprosy disease is a chronic infection caused by the acid fast bacillus Mycobacterium laprae. It mainly affects the superficial tissue especially the skin and peripheral nerve. Classification of leprosy disease is very important for its proper treatment. Misclassification increases the rate of relapse due to insufficient treatment if a Multibacillary patient is treated as Paucibacillary patient. Effective treatment is available for leprosy treatment that is available and free of cost at all health care facilities.

Classification of Leprosy:

Leprosy disease is mainly classified for the purpose of proper treatment includes the number of skin lesions and the nerves involvement. It can be classified based on clinical manifestations and skin smear results.

According to purpose of treatment:

1. Paucibacillary Leprosy:

There will be 1 to 5 skin lesion and only one nerve involvement. The patient will present as definite loss of sensation and skin smear test is negative at all sites.

2. Multibacillary Leprosy:

There will be more than five skin lesions and 2 or more nerve involvement. The present may or may not loss the sensation and skin smear test is positive at any site.

According to clinical classification:

1. Tubercloid (TT),
2. Borderline Tuberculoid (BT),
3. Mid Borderline (BB),
4. Borderline Lepromatous (BL),
5. Lepromatous (LL),
6. Neural leprosy: It is unusual type of leprosy that only affect nerve without any skin changes.

Treatment of Leprosy Disease:

The key factor of leprosy disease treatment is early detection and starts enough treatment as soon as possible. That will help to prevent debilitating of the patient. Several drugs are used to treat leprosy that is known as multidrug therapy (MDT). Single dose never use as treatment of leprosy disease.

• Rifampicine,
• Clofazimine,
• Dapsone,
• Fluoroquinolone,
• Macrolides and Minocycline,
• Ofloxacin,
• Azithromycin.

To control of inflammation also prescribed-

• Prednisone,
• Aspirin,
• Thalidomide.

Multidrug Therapy Treatment for Leprosy Disease:

Multidrug therapy is recommended for leprosy disease treatment as primary drug (Dapsone) has become resistance. Dapsone prevents the formation of folic acid, thereby inhibiting the organism’s replication. Rifampicin and Clofazimine are two most common additional drugs to treat leprosy. Those three drugs are taken orally can be administered on an outpatient basis under monthly supervision. Dose and duration of treatment varies according to the stage of disease and whether the patient is an adult or child.

Multidrug Therapy (MDT) Plan Recommended by WHO:

Types of Leprosy	Name of Drugs	Frequency of administration	Dosage for Adult (15 years and above)	Dosage for Children ( 10-14 years)	Dosage for Children below 10 years	Month of treatment
Paucibacillary	Rifampicin	Once monthly	600mg	450mg	300mg	Completion of 06 months pulses 09 consecutive months.
	Dapsone	Daily	100mg	50mg	25mg
Multibacillary	Rifampicine	Once monthly	600mg	450mg	300mg	Completion of 12months pulses in 18 consecutive months.
	Clofazimine	Monthly	300mg	150mg	100mg
	Dapsone	Daily once	100mg	50mg	25mg
	Clofazimine	Daily for adults ( every alternative day for children)	50mg	50mg	50mg (every alternative day not daily)

Surgical Treatment of Leprosy Disease:

Beside of multidrug therapy some surgical treatments are available for leprosy patients those are pointed below:

1. Fascicular dissection: Drainage of acute nerve abscesses and fasicular dissection can reduce pressure on nerve and can improve sensation.
2. Longitudinal Epineurotomy: It helps to reduce pressure, allows restoration of Intraneuronal blood flow of the Carpal Tunnel.
3. Z-plasty: It helps to improve the functional and cosmetic appearance of leprosy scars.
4. Tarsorrhaphy: It is surgical procedure to help narrow of the upper and lower eyelids so as to partially close the eye.
5. Canthoplasty: Reduce sagging of the eyelids.
6. Nasal reconstruction.
7. Removal of excess skin.
8. Replacement of eyebrows.
9. Amputation: It is the last resort and reserved for cases of extremely damaged tissue.

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