Leprosy

Diagnosis and Treatment

DR. Dr. M. Yulianto Listiawan, SpKK(K),

FINSDV, FAADV

Diagnosis

of leprosy is based on clinical

signs and symptoms.
ONE of following cardinal sign:
1. Hypopigmented or reddish skin
lesion(s) with definite loss of sensation;
2. Involvement of the peripheral nerves,
as demonstrated by loss of sensation and
weakness of the muscles of hands, feet
or face;
3. skin smear positive for acid-fast bacilli.

Skin lesion
- single or multiple,
- usually less pigmented than the
surrounding
normal skin
- sometimes the lesion is reddish or coppercoloured
- a variety of skin lesions may be seen but
macules (flat), papules (raised), or
nodules
are common

Sensory

loss is a typical feature of leprosy

The

skin lesion may show loss of

sensation to pin pick and/or light touch

thickened nerve is often accompanied

by other signs as a result of damage to
the nerve.
These may be loss of sensation in the
skin and weakness of muscles supplied
by the affected nerve

Memiliki sifat
4A :
Anaesthesi
Anhydrosis
Achromia
Atrophy

Light touch
Temperature
discrimination
Pain (pin prick)

NERVE ENLARGEMENT

BI: total number of bacilli

MI: % of solid staining bacilli, number of viable
bacilli

Classification of leprosy

Leprosy

can be classified on the basis

of clinical manifestations and skin
smear results.
Skin smears
1. Paucibacillary leprosy (PB) :
negative
smears at all sites
2. Multibacillary leprosy (MB) : positive
smears at any site

Clinical

criteria for classifying and

deciding the appropriate treatment
regimen for individual patients
(particularly in view of the nonavailability or non-dependability of the
skin-smear services)

Paucibacillary

leprosy : 2-5 skin lesions

Multibacillary

leprosy : > five skin lesions

Lepromin test
Phenolic
Glyco
Lipid-1

Up to 109 bacteria
per gram tissue

GAMBARAN KLINIK
M.H.
TUBERCULOID
LEPROMATOUS
CELLULAI
R
IMMUNITY

BORDERLINE

HUMORAL
IMMUNITY

JUMLA
H
BASIL
KUSTA

LEPROSY CLASIFFICATION
WHO (1980 ):

Pausi-Basiler (PB)
MULTI-BASILER (MB)

Polar Tuberculoid Type

( TT )

Borderline Tuberculoid
( BT )

Midborderline
( BB type)

Borderline Lepromatous
( BL )

Polar Lepromatous ( LL )

LEPROSYS COMPLICATION

1.
2.
3.
4.
5.

Madarosis
Saddle nose
Gynecomastia
Hand and foot dissability
REACTION OF LEPROSY

Lagoptalm
us of
reaction

SADDLE NOSE

WHO Recommended treatment

regimens
6 Month regimen for Paucibacillary (PB)
Leprosy

Dapsone

Rifampicin

Adult
50 - 70 kg

100 mg
Given daily

600 mg
Given once a month
under supervision

Child
10 - 14 yearsa

50 mg
Given daily

450 mg
Given once a month
under supervision

Adjust dose appropriately for child less than 10 years. For

example, dapsone 25 mg daily and rifampicin 300 mg given once a
month under supervision
a

12 month regimen for Multibacillary

(MB) Leprosy
Dapsone

Adult
50 - 70 kg

Child
10 - 14
yearsb

Rifampici
n

Rifampici
n

100 mg
600 mg
50 mg
Given daily Given once Given daily
a month
under
supervision

Clofazimi
ne
AND 300
mg
Given once
a month
under
supervision

50 mg
450 mg
50 mg
AND 150
Given daily Given once Given
mg
a month
every other Given once
under
day
a month
supervision
under
b
Adjust dose appropriately for child less than 10 years. For supervision
example, dapsone 25 mg daily, rifampicin 300 mg given once a
month under supervision, clofazimine, 50 mg given twice a week,
and clofazimine 100 mg given once a month under supervision