rifampin and Erythema-Nodosum

Histoid leprosy is a particular variant of lepromatous leprosy presenting as cutaneous or subcutaneous nodular and/or plaque-like lesions arising form apparently normal skin. It is characterized histologically by spindle-shaped histiocytes in interlacing bundles and whorls, containing numerous intact and rod-shaped Mycobacterium leprae. It can occur de novo or secondary in patients treated for a long course by dapsone alone. We describe a case of lepromatous leprosy treated according to the national Moroccan protocol who developed histoid lesions during his treatment by dapsone. The patient responded well to fluoroquinolone, rifampicin and clofazimine, with however, the occurrence of erythema nodosum leprosum.

Topics: Adult; Clofazimine; Dapsone; Erythema Nodosum; Fluoroquinolones; Histiocytes; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Mycobacterium leprae; Rifampin

Topics: Antigens, Bacterial; Clofazimine; Dapsone; Erythema Nodosum; Humans; Immune Tolerance; Immunity, Cellular; Leprostatic Agents; Leprosy; Lymphocyte Activation; Mycobacterium leprae; Neutrophils; Rifampin

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Clofazimine; Cohort Studies; Dapsone; Erythema Nodosum; Female; Humans; Indoles; Leprostatic Agents; Leprosy; Leukotriene Antagonists; Male; Middle Aged; Nerve Degeneration; Phenylcarbamates; Prednisone; Rifampin; Sulfonamides; Thalidomide; Tosyl Compounds

Between 1980 and 1994, 67 new or relapsing leprosy patients were treated by daily administered multidrug regimens. Tuberculoid patients (23 TT/BT) received either bitherapy [rifampin + dapsone or clofazimine (RMP + DDS or CLO)] or tritherapy [RMP + DDS and/or CLO and/or ethionamide (ETH)] until clinical cure. Lepromatous patients (44 BB/BL/LL) received tritherapy (RMP + DDS and/or CLO and/or ETH) at least until bacteriological negativity. Of the 23 tuberculoid patients only one patient (5%) was cured at 6 months and about 70% needed between 6 and 24 months of treatment to obtain clinical cure (mean 19.5 months). In the 44 lepromatous patients, the achievement of bacteriological negativity was significantly linked to the initial bacterial index (BI), and it occurred after 2 to 7 years (mean 66.5 months) of multidrug therapy (MDT). The average BI decrease per year was 1.1+ during the first year, 0.9+ the second year, and then < 0.5+ per year. Reactional states significantly (p < 0.01) influenced the BI course: reversal reactions (RR) accelerated while erythema nodosum leprosum (ENL) delayed the BI decrease. Three of the 23 (13%) tuberculoid and 19 of the 44 (43%) lepromatous patients (p < 0.02) exhibited a RR and 18 of 44 (41%) lepromatous patients had ENL during MDT. A late RR (LRR) was observed in 1 (5%) and 6 (17%) of our tuberculoid and lepromatous patients, respectively, and 3 (8%) of our lepromatous patients suffered post-MDT ENL. No confirmed relapse has been observed within a follow-up period of 6 months to 7 years and 3 months [59 person-years at risk (PYR)] for TT/BT patients and of 4 months to 5 years and 10 months (100 PYR) for BB/BL/LL patients. When compared to the recommended WHO/MDT, it appears that daily MDT does not increase the clinical or the bacteriological cure rates either at 6 months in paucibacillary tuberculoid patients or at 2d years in multibacillary lepromatous patients. Moreover, as does the WHO/MDT, our regimens show a high frequency of reactional states both during and after treatment. This fact constitutes the main new problem of the actual treatment of leprosy.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Clofazimine; Dapsone; Drug Resistance, Microbial; Drug Therapy, Combination; Erythema Nodosum; Ethionamide; Female; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Leprosy, Tuberculoid; Male; Middle Aged; Recurrence; Rifampin

Previous studies have shown that when multibacillary leprosy patients were treated with recombinant human interferon gamma (rhuIFN-gamma) for 6-10 months there was an accelerated reduction in the number of acid-fast bacilli in the skin at the site of injection as well as an accelerated bacillary reduction at distal sites. However, this favorable out-come of IFN-gamma treatment was associated with the development of erythema nodosum leprosum (ENL). The present study was undertaken to investigate whether rhuIFN-gamma-induced bacillary clearance could be disassociated from the induction of ENL. rhuIFN-gamma was administered together with thalidomide and conventional multidrug chemotherapy to newly diagnosed leprosy patients. During treatment with this combination of drugs, the mean reduction in bacterial load was the same as the reduction observed with chemotherapy alone. Moreover, the inclusion of thalidomide in the treatment regimen was associated with a low frequency of ENL episodes. A second group of leprosy patients, who had already completed 2 years of chemotherapy, were treated with rhuIFN-gamma only. In those patients who were skin bacilli negative, ENL did not occur during rhuIFN-gamma treatment. In contrast, in bacilli-positive patients the frequency of ENL during rhuIFN-gamma treatment was higher, as was the occurrence of local erythema and induration. However, rhuIFN-gamma treatment without concomitant chemotherapy did not result in a reduction in the bacterial load in the skin of bacilli-positive patients. These findings, taken together, indicate that rhuIFN-gamma does not, by itself, accelerate bacterial clearance, but requires concomitant chemotherapy to achieve the accelerated reduction in bacillary load. Thalidomide reduces the frequency of IFN-gamma-induced ENL, but also eliminates the IFN-gamma-induced bacillary clearance.

Topics: Clofazimine; Dapsone; Drug Therapy, Combination; Erythema Nodosum; Humans; Interferon-gamma; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Mycobacterium leprae; Recombinant Proteins; Rifampin; Skin; Thalidomide

A double blind trial involving intermittent administration of Rifampicin in addition to daily DDS has been undertaken in order to evaluate the efficacy as also the potential dangers of such a regimen. Twenty untreated LL cases who were otherwise healthy were included in the study. Ten cases received weekly 900 mg Rifampicin for 6 weeks in addition to 100 mg daily DDS, while the rest were treated likewise but were given similar looking placebo capsules instead of RFP. A nine month follow-up, as also mouse foot pad results indicate that the efficacy of this regimen was found to be better than that with DDS alone and this compares favourably with trials involving 600 mg Rifampician administration daily. No major untoward side effects were encountered in the trial group thought the incidence of ENL was slightly higher in the trial group.

Topics: Alanine Transaminase; Animals; Aspartate Aminotransferases; Clinical Trials as Topic; Dapsone; Double-Blind Method; Drug Therapy, Combination; Erythema Nodosum; Humans; Leprosy; Mice; Mitotic Index; Mycobacterium leprae; Rifampin; Time Factors

Patients with borderline-lepromatous (BL) or fully lepromatous (LL) leprosy were treated in the sanitarium for approximately 1 year with oral rifampin (600 mg daily) or with oral dapsone (100 mg daily). They were then treated as outpatients with intramuscular acedapsone (225 mg every 12 weeks) or oral dapsone (50 mg daily). They have now been followed for a total of 28 to 34 months. Death of Mycobacterium leprae during the initial 24 weeks was monitored by mouse inoculation with M. leprae from skin punch biopsy specimens. With rifampin therapy, death of M.leprae occurred rapidly, and viable M. leprae were nearly undetectable by the time the first specimen was taken after the start of treatment, at 4 weeks. With dapsone therapy, death of M. leprae was slower, and in some cases the inoculation results were still positive at 12 weeks. The therapeutic response during the period of outpatient treatment has been satisfactory. The number of dead M. leprae, as measured by the bacterial index in skin smears and the number of acid-fast bacteria in skin specimens, has continued to decrease, and clinical progress has been satisfactory. The measured drug-induced death of M. leprae occurred at about the same rate in BL patients as in LL patients. Disappearance of dead M. leprae from the tissues was much more rapid in BL patients than in LL patients.

Topics: Acetamides; Animals; Clinical Trials as Topic; Dapsone; Drug Administration Schedule; Erythema Nodosum; Humans; Leprosy; Mice; Microbial Sensitivity Tests; Mycobacterium leprae; Philippines; Recurrence; Rifampin; Sulfones; Time Factors

Topics: Drug Resistance; Erythema Nodosum; Humans; Leprosy; Leprosy, Lepromatous; Rifampin; Steroids

Lepromatous leprosy is associated with a high bacillary load and poor cellular immune response. Early dermatologic manifestations include erythematous macules, papules, nodules, and plaques with a symmetrical distribution. Leprosy also shows two major reaction states including type I (reversal reaction) and type II (vasculitis). These reactions are usually seen in some patients who are undergoing treatment. Herein, we report an interesting patient with lepromatous leprosy who presented with skin lesions of type II reaction without receiving any anti-leprosy treatment and surprisingly showed a type I reaction eight months after the beginning of the treatment.

Topics: Clofazimine; Dapsone; Disease Progression; Drug Therapy, Combination; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Middle Aged; Rifampin; Treatment Outcome

Topics: Antifungal Agents; Brazil; Dapsone; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Prednisone; Recurrence; Rifampin; Terbinafine; Thalidomide; Tinea; Trichophyton; Young Adult

Verrucous leprosy is rare, with only 18 cases reported in the literature. Visceral involvement is frequent but often overlooked, causing significant morbidity and mortality.. A 45-year-old Filipino male with a 16-year history of hyperpigmented, hypoesthetic plaques, amputated digits, enlarged ulnar nerve, and cardiovascular congestion was diagnosed with Hansen's disease-lepromatous type. He had multiple cauliflower-like nodules and plaques with foul-smelling discharge on the lower extremities presenting a diagnostic dilemma. After an exhaustive search, the causative agent for these verrucous nodules was confirmed to still be Mycobacterium leprae. In addition, he had glomerulonephritis, hypertension, congestive heart failure, deep venous thrombosis, neuritis, keratitis, and glaucoma, which are all complications of advanced leprosy and multiple attacks of erythema nodosum leprosum reactions.. He was treated with a multibacillary regimen of Rifampicin, Dapsone, Clofazimine, and systemic corticosteroids, with remarkable improvement.

Topics: Biopsy; Clofazimine; Dapsone; Drug Therapy, Combination; Erythema Nodosum; Glucocorticoids; Humans; Leg Dermatoses; Leprostatic Agents; Leprosy, Lepromatous; Male; Middle Aged; Philippines; Prednisone; Rifampin

Florid reactive periostitis ossificans is a rare bone lesion usually occurring in the small, tubular bones of the hands and feet. This entity is a benign and aggressive periosteal reaction associated with soft tissue swelling that appears similar to a bone lesion that radiographically and clinically mimics an infectious or neoplastic process. Typically the lesions occurs in an adolescent or young adult and presents as a small area of painful swelling and erythema over the affected bone. The cause of florid reactive periostitis ossificans is not exactly known though many authors have postulated varied etiopathogenesis for the same condition. In this report, is a very rare and unusual example of this entity that has been observed in association with erythema nodosum leprosum (ENL) a type 2 lepra reaction in a Leprosy patient.

Topics: Adolescent; Clofazimine; Dapsone; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Osteitis; Periostitis; Radiography; Rifampin; Treatment Outcome

Clofazimine enterophathy is a serious complication of clofazimine when used at high doses for treatment of type 2 lepra or or erythema nodosum leprosum. Objective. A woman is presented who had a delayed diagnosis of leprosy, persistent type 2 lepra reaction and lethal clofazimine enteropathy.. A 31-year-old woman presented leprosy symptoms over a 16-year period without medical diagnosis of her disease. During this period, type 2 lepra episodes occurred, but were not accurately diagnosed. These episodes became more severe during her second pregnancy. The patient and her family were interviewed, and her clinical history reviewed.. After twelve years of medical consults, lepromatous leprosy was diagnosed, based on perforation of her nasal septum, with a bacterial index of 5. Her husband and a 12-year-old daughter have leprosy symptoms. During multidrug therapy, she presented with repeated type 2 lepra reaction episodes for which she received daily clofazimine 400 mg doses. Two months after this treatment, severe and frequent episodes of intense abdominal pain began to occur. These persisted for more than a year and were managed with in-hospital administration of several classes of painkillers and antispasmodic medication, including morphine. She also presented with sporadic diarrhea, constipation, nausea, weight loss and mesenteric adenopathies. She died finally due to this intestinal condition. No autopsy was performed.. The patient's clinical presentation suggested a clofazimine-induced lethal enteropathy, a complication not previously seen in Colombia. This connection was not recognized by the medical officers that treated the patient.

Topics: Abdominal Pain; Adult; Arthritis, Rheumatoid; Child; Child, Preschool; Clofazimine; Constipation; Diagnostic Errors; Diarrhea; Drug Therapy, Combination; Erythema Nodosum; Family Health; Fatal Outcome; Female; Humans; Intestinal Diseases; Leishmaniasis, Mucocutaneous; Leprostatic Agents; Leprosy, Lepromatous; Male; Paresthesia; Pregnancy; Pregnancy Complications, Infectious; Rifampin

Topics: Antitubercular Agents; Child, Preschool; Erythema Nodosum; Female; Humans; Lymphadenitis; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin; Tuberculin Test

Leprosy affects skin and peripheral nerves, and acute inflammatory type 1 reactions (reversal reaction) can cause neurologic impairment and disabilities. Single skin lesion paucibacillary leprosy volunteers (N = 135) recruited in three Brazilian endemic regions, treated with single-dose rifampin, ofloxacin, and minocycline (ROM), were monitored for 3 years. Poor outcome was defined as type 1 reactions with or without neuritis. IgM anti-phenolic glycolipid I, histopathology, Mitsuda test, and Mycobacterium leprae DNA polymerase chain reaction (ML-PCR) were performed at baseline. chi(2) test, Kaplan-Meir curves, and Cox proportional hazards were applied. The majority of volunteers were adults with a mean age of 30.5 +/- 15.4 years; 44.4% were ML-PCR positive. During follow-up, 14.8% of the patients had a poor clinical outcome, classified as a type 1 reaction. Older age (> or = 40 years), ML-PCR positivity, and lesion size > 5 cm were associated with increased risk. In multivariate analysis, age (> or = 40 years) and ML-PCR positivity remained baseline predictors of type 1 reaction among monolesion leprosy patients.

Topics: Adolescent; Adult; Aging; Cohort Studies; DNA, Bacterial; Erythema Nodosum; Female; Humans; Leprosy; Male; Middle Aged; Minocycline; Mycobacterium leprae; Ofloxacin; Polymerase Chain Reaction; Rifampin; Risk Factors; Time Factors

Erythema nodosum rarely occurs in childhood and can be caused by cat scratch disease, as a result of agent Bartonella henselae. We report the case of a teenager who presented erythema nodosum and bilateral inguinal adenitis. Cat scratch disease diagnosis was confirmed by anti-Bartonella henselae serologies. Despite an appropriate antibiotic therapy, evolution was unfavourable with adenitis abcédation requiring surgical drainage.. Erythema nodosum in children must let think to cat scratch disease among others etiologies.

Topics: Abscess; Administration, Oral; Adolescent; Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Drainage; Erythema Nodosum; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Groin; Humans; Immunoglobulin G; Male; Rifampin; Time Factors; Treatment Outcome

We report a patient with lepromatous leprosy who developed a rare variant of type-2 lepra reaction, characterized by pustular lesions, on switching from WHO multi drug therapy (MDT) to ofloxacin-aided MDT.

Topics: Abscess; Adult; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Macrophages; Male; Melanins; Minocycline; Mycobacterium tuberculosis; Neutrophils; Ofloxacin; Rifampin; Tumor Necrosis Factor-alpha; Vasculitis

The severity and outcome of a chronic granulomatous infection caused by M. leprae depend on the cell-mediated immunity towards the pathogen. The disease classification is based on the host's response to M. leprae ranging from high to low resistance (polar tuberculoid leprosy to polar lepromatous leprosy). The host's position in the spectrum is not stable; leprosy reactions reflecting changed immune status may occur spontaneously or during chemotherapy. The type II reaction or erythema nodosum leprosum can most often be seen in patients with lepromatous leprosy, a multiorgan disease characterized by an unrestricted bacillary replication. Clinically, this reaction is characterized by crops of painful bright pink, dermal and subcutaneous nodules arising in clinically normal skin, in association with fever, malaise, glomerulonephritis and arthralgias. Therefore, prompt institution of immunosuppressive therapy with corticosteroids or thalidomide is recommended. This case report describes the development of erythema nodosum leprosum during chemotherapy treated successfully with thalidomide. Furthermore, immunologic effects and potential side effects of this drug are discussed.

Topics: Adult; Dapsone; Dermatologic Agents; Drug Therapy, Combination; Erythema Nodosum; Follow-Up Studies; Humans; Immunosuppressive Agents; Leprostatic Agents; Leprosy, Lepromatous; Male; Prothionamide; Rifampin; Thalidomide; Time Factors

We describe a patient with a diagnosis of Hansen's disease borderline type, presenting as cutaneous lesions and silent multineuritis. Samples of nasal mucus, earlobe and cutaneous lesions were positive for acid-fast bacilli. He was given treatment with rifampin, dapsone and clofazimine. Five years later, he developed fever, poliarthritis, orchitis and hepatic involvement. Searching for acid-fast bacilli in many cutaneous and mucosal locations was fruitfulness. Because of clinical suspicion of erythema nodosum leprosum, he was treated with steroids with improvement of his clinical picture, but subsequently he developed multineuritis with many sensitive symptoms. A high number of bacilli was seen in nerve biopsy. We comment on atypical features of clinical evolution and erythema nodosum leprosum, and emphasize the significance of large number of bacilli into peripheral nerve in contrast with their absence at other levels.

Topics: Biopsy; Clofazimine; Dapsone; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Male; Middle Aged; Neuritis; Peripheral Nerves; Rifampin

Topics: Adult; Drug Eruptions; Erythema Nodosum; Female; Humans; India; Leprostatic Agents; Leprosy, Lepromatous; Rifampin; Urticaria

Report on the results with a new therapy with a complex combination (rifampicin + co-trimoxazole + isoniazid) for the treatment of leprosy. High tolerance. Duration of treatment 2 months.

Topics: Adult; Aged; Drug Therapy, Combination; Erythema Nodosum; Female; Follow-Up Studies; Humans; Isoniazid; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Middle Aged; Recurrence; Rifampin; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Melanesian leprosy patients from New Caledonia were studied for the following parameters during the course of polychemotherapy: peripheral blood T-cell subsets, as identified in an immunofluorescence assay with monoclonal antibodies OKT3 ("pan-T"), OKT4 ("helper/inducer"), and OKT8 ("cytotoxic-suppressor"), and anti-Mycobacterium leprae antibodies in the serum, as measured by the fluorescent leprosy antibody absorption test. A group of Melanesian healthy subjects with no known exposure to M. leprae served as controls. Healthy contacts of leprosy patients were also studied for the presence of anti-M. leprae antibodies. Untreated, nonreactional lepromatous patients displayed moderate but significant T-cell abnormalities, consisting of a decrease in the percentage of OKT3+ and OKT4+ cells with a decrease in the OKT4:OKT8 ratio. These abnormalities disappeared within nine months of treatment. A transient decrease in the percentage of OKT8+ cells with an increase in the OKT4:OKT8 ratio was seen in patients suffering erythema nodosum leprosum (ENL). Tuberculoid patients, whether treated or not, did not show any T-cell marker disturbances. Positive serological tests for anti-M. leprae antibodies were found in 100% of lepromatous patients, 92% of tuberculoid patients, and 56% of healthy contacts. No significant decline in the antibody titer was observed with treatment during the survey period.

Topics: Adolescent; Adult; Antibodies, Bacterial; Child; Clofazimine; Dapsone; Drug Therapy, Combination; Erythema Nodosum; Ethionamide; Fluorescent Antibody Technique; Humans; Leprosy; Middle Aged; Mycobacterium leprae; New Caledonia; Rifampin; T-Lymphocytes; T-Lymphocytes, Cytotoxic; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory

A systematic study was performed on the reactions occurring during several short-course therapy regimens for the treatment of paucibacillary and multibacillary patients. Most type 1 upgrading reactions in paucibacillary (PB) leprosy were mild to moderate and of short duration, while the time of onset was extremely variable. Their incidence was higher in the regimen rifampin (RMP) 900 mg once weekly for ten weeks than when a single dose of RMP 40 mg/kg body weight was given or 1500 mg in one dose followed by one year of dapsone (DDS) 100 mg daily. In multibacillary (MB) leprosy, three regimens were compared: MB-WHO regimen; regimen C, consisting of daily RMP 600 mg, ethionamide (ETH) 500 mg, and DDS or clofazimine (CLO) 100 mg for six months, followed by six months of daily DDS or CLO; and regimen D, identical to regimen C but comprising daily DDS or CLO plus ETH 500 mg during the second semester. Type 1 upgrading reactions occurred more frequently in MB patients and were more severe than in PB patients. They occurred more frequently and were more severe in regimens C and D than in the MB-WHO regimen. CLO 100 mg daily prevented type 1 reactions in MB patients and rendered them less severe. ENL was also more frequent in regimens C and D and was not prevented by CLO in the dosage used. Although there is some correlation between type 1 reactions and the total amount of RMP administered, other aspects of RMP administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Child; Clofazimine; Dapsone; Drug Therapy, Combination; Edema; Erythema Nodosum; Ethionamide; Female; Humans; Leprostatic Agents; Leprosy; Male; Neuritis; Prospective Studies; Rifampin

An electrogustometric study of 225 cases of Hansen's disease revealed impairment of taste in 55.1% of the cases. It was related to the duration of the disease, and was seen in 74.6% of the cases of lepromatous leprosy, 49.3% of the cases of borderline leprosy, and 41.3% of tuberculoid leprosy cases. Only in lepromatous cases was complete ageusia seen (9.39% of cases). All of the cases having lesions in the oropharynx and those with facial nerve palsy revealed impairment of taste, but it was not related to the type of antileprosy drug used or to the development of ENL reaction.

Topics: Adolescent; Adult; Ageusia; Clofazimine; Dapsone; Erythema Nodosum; Facial Paralysis; Female; Humans; Leprosy; Male; Rifampin; Taste Disorders

Topics: Adult; Animals; Clofazimine; Dapsone; Drug Resistance, Microbial; Erythema Nodosum; Ethionamide; Humans; Leprosy; Mycobacterium leprae; Patient Compliance; Prothionamide; Rifampin

The basis of the immunological unresponsiveness seen in leprosy patients is unknown. Untreated lepromatous leprosy patients display an unspecific cellular anergy which disappears with treatment, leaving an anergy specific for Mycobacterium leprae. These patients suffer from a complication, erythema nodosum leprosum, characterized by a recurrent eruption of tender skin nodules disappearing in 2 to 3 days. These nodules show a histological picture reminiscent of an Arthus reaction. Erythema nodosum leprosum can occur in untreated patients but it is more frequent in those receiving effective chemotherapy, and this has been thought to be due to massive release of antigen from the bacilli. By using monoclonal antibodies detecting different subpopulations of human peripheral blood T lymphocytes, we have shown that both borderline lepromatous leprosy patients had increased circulating suppressor cells (P less than 0.001) while the total number of T cells was within the normal range. The suppressor-cell population decreased with the duration of treatment, the change being evident at as early as 21 days. Five patients developed erythema nodosum leprosum during the study period. In all these patients the number of suppressor cells was decreased prior to the complication, increasing to original values with clinical recovery from this syndrome. There was no significant effect on T-lymphocyte subpopulations during chemotherapy of borderline tuberculoid leprosy patients. It seems that antileprosy chemotherapy precipitates erythema nodosum leprosum by interfering with immunoregulatory T cells.

Topics: Antibodies, Monoclonal; Dapsone; Erythema Nodosum; Humans; Leprosy; Lymphocyte Activation; Mycobacterium leprae; Rifampin; T-Lymphocytes; Thalidomide

Topics: Dapsone; Drug Therapy, Combination; Erythema Nodosum; Female; Humans; Leprosy; Malaysia; Male; Mycobacterium leprae; Rifampin

Leprosy is a complex disease, but recent research and the Ridley-Jopling classification which emphasize its immunologic aspects have greatly aided our understanding of and approach to the problem. The diagnosis should be considered whenever skin lesions and sensory loss occur. Dapsone remains the treatment of choice, but several newer drugs show great promise, especially in those cases whose bacilli have become sulfone resistant. Immunotherapy may play an increasingly prominent role in the future. Reactive episodes continue to be a serious complication, but the availability of thalidomide to control erythema nodosum leprosum has markedly improved the prognosis. Physicians of the US Public Health Service Hospital at Carville, Louisiana, are available at all times for consultation on these and other matters related to leprosy.

Topics: Biopsy; Clofazimine; Dapsone; Erythema Nodosum; Humans; Immunotherapy; Leprosy; Recurrence; Rifampin; Sensation; Skin; Thalidomide; United States

Topics: Chloroquine; Clofazimine; Dapsone; Drug Resistance, Microbial; Erythema Nodosum; Humans; Leprosy; Prednisone; Rifampin; Thalidomide