Dermatologic Manifestations of Leprosy Medication

Updated: May 14, 2018
  • Author: Felisa S Lewis, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Antimicrobials

Class Summary

Antimicrobials are used to eliminate organisms. The first-line drugs are dapsone, rifampin, and clofazimine. Clofazimine can also be used alone to treat type II (ENL) reactions. Second-line agents include minocycline, ofloxacin, and clarithromycin, which can be used to treat a single skin lesion or to treat patients with dapsone allergy.

Dapsone (Avlosulfon)

Dapsone blocks folic acid synthesis. It is bacteriostatic and weakly bactericidal. It was widely used as monotherapy for leprosy until resistance developed. Now it is part of MDT for leprosy.

Rifampin (Rifadin, Rimactane)

Rifampin is bactericidal for M leprae. It inhibits DNA-dependent RNA polymerase, interfering with bacterial RNA synthesis. It is part of MDT for leprosy.

Clofazimine (Lamprene)

Clofazimine is a red, fat-soluble, crystalline dye. It inhibits mycobacterial growth and binds preferentially to mycobacterial DNA. It has antimicrobial properties. One mechanism of action may be to modulate M leprae-mediated effects on ADRP and HSL, subsequently affecting lipid metabolism in macrophages. It is slowly bactericidal against M leprae. Clofazimine has anti-inflammatory properties.

Minocycline (Minocin)

Minocycline is bacteriostatic. It inhibits bacterial protein synthesis by reversibly binding at the 30S unit.

Ofloxacin (Floxin)

Ofloxacin is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effects. It inhibits DNA gyrase, interfering with bacterial DNA synthesis.

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Corticosteroids

Class Summary

These anti-inflammatory agents are used primarily in the treatment of type I (reversal) reactions and silent neuropathy (see Complications). These drugs can be used to treat leprosy reactions when a risk of neurologic deficits is present or when moderately inflamed lesions occur in cosmetically important places. Systemic corticosteroids may also be used to treat type II reactions.

Prednisone (Deltasone)

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. It stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

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Immunomodulators

Class Summary

These agents are especially useful in treating type II (ENL) reactions. Thromboembolic events are reported with thalidomide use.

Thalidomide (Thalomid)

Thalidomide is an immunomodulatory agent that may suppress excessive production of TNF-alpha and down-regulate selected cell-surface adhesion molecules involved in leukocyte migration. It can be used to treat recurrent or refractory ENL.

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