Leprosy Treatment: Multidrug Therapy, Surgery & Rehabilitation Guide
Leprosy (Hansen's Disease): Comprehensive Treatment Overview
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Modern multidrug therapy (MDT) has made it curable, with global elimination as a public health problem achieved in 2000. Early treatment prevents disability.
1. Multidrug Therapy (MDT) - Cornerstone of Treatment
WHO-recommended regimens (free globally since 1995):
| Type | Drugs | Duration | Key Points |
|---|
| Paucibacillary (PB) | Dapsone + Rifampicin | 6 months | 1-5 skin lesions; no bacilli on smear |
| Multibacillary (MB) | Dapsone + Rifampicin + Clofazimine | 12 months | >5 lesions or positive smear; clofazimine prevents resistance |
MDT Key Principles
- Fixed-dose combination blister packs ensure adherence
- Directly observed therapy (DOT) in some programs
- Rifampicin monthly (supervised); dapsone/clofazimine daily (self-administered)
- Cure rates >95% with completion
- Relapse rates: <1% PB, ~1% MB
2. Surgical Interventions
For established deformities (after MDT completion and infection control):
- Tendon transfers - Restore hand function (claw hand correction)
- Nerve decompression - Release entrapment (ulnar at elbow, median at wrist)
- Reconstructive surgery - Nose collapse (saddle nose), eyebrow loss, lagophthalmos
- Amputation - Last resort for non-healing trophic ulcers with osteomyelitis
3. Physiotherapy
- Prevent contractures through splinting and positioning
- Strengthen antagonist muscles to balance paralysis
- Sensory re-education for anesthetic areas
- Ulcer care: offloading, dressings, footwear modification
4. Occupational Therapy
- Adaptive devices for daily living (button hooks, built-up utensils)
- Vocational retraining for livelihood preservation
- Income-generation programs (WHO-supported in endemic areas)
- Community-based rehabilitation (CBR) models
5. Psychological & Social Support
- Stigma reduction: community education, "Hansen's disease" terminology
- Counseling for depression, anxiety, body image concerns
- Family inclusion in care to prevent isolation
- Legal advocacy against discrimination (employment, marriage, housing)
6. Leprosy Control Programs
- Active case finding in endemic areas
- Contact tracing and surveillance (5-year follow-up)
- Chemoprophylaxis for contacts (single-dose rifampicin)
- Disability grading at diagnosis and discharge (WHO grades 0-2)
- Integration into general health services
Critical Clinical Pearls
- MDT must be completed fully - incomplete treatment breeds resistance
- Reactions (Type 1 reversal, Type 2 ENL) need prompt steroid/thalidomide management
- Neuropathic ulcers require lifelong foot care to prevent amputation
- Eye care (lagophthalmos, corneal anesthesia) prevents blindness
Global Status
WHO reports ~200,000 new cases annually (2023), mostly in India, Brazil, Indonesia. Zero leprosy roadmap targets: zero transmission, zero disability, zero discrimination by 2030.
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