Clinical Review

Diagnosing and Treating Hansen's Disease

Clinician Reviews. 2009 December;19(12):15-19

References

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2. World Health Organization Communicable -Diseases Department. Leprosy: frequently as-ked questions. www.searo.who.int/EN/Section10/Section373_11716.htm. Accessed November 17, 2009.

3. National Hansen’s Disease (Leprosy) Program. www.hrsa.gov/hansens. Accessed November 23, 2009.

4. Health Resources and Services Administration, US Department of Health and Human Services, National Hansen’s Disease Program. A summary of Hansen’s disease in the United States—2006. ftp://ftp.hrsa.gov/hansens/2006RegistryReport.pdf. Accessed November 17, 2009.

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Clofazimine, a soft gelatin capsule, may cause gray-blue or red hyperpigmentation in individuals who are light-skinned; this effect reverses once the drug is discontinued. Nausea, vomiting, and abdominal pain have been reported. This slow-release bactericidal drug has an extremely long half-life of 70 days. It provides anti-inflammatory action similar to that of prednisone without the latter agent’s long-term adverse effects.²⁴

The Patient’s Outcome
The case patient was the second with HD seen in this dermatology practice. A man who presented on an earlier occasion, possibly an undocumented worker in fear of deportation, seemed concerned about the reporting process, even though he was assured that no personal information would be released. He did not return for follow-up, and attempts to reach him proved fruitless.

The case patient, by contrast, was pleasant and cooperative. He appeared to understand his condition, the required treatment and its possible adverse effects, and the need for continued lab work and regular follow-up appointments. A day laborer in a large factory, he was particularly careful to avoid transmission of his illness to his family or co-workers.

Within two months of beginning multidrug therapy, he experienced quick clearance of the lesions on his back. His bacterial index approached 0 by the time he underwent the second smear. Although he complained of loose stools and classic orange-red bodily fluid throughout the entire year of treatment, he resisted the temptation to discontinue the regimen.

He has experienced no relapses in six years and is considered cured.

Conclusion
Only one in every 20 people is susceptible to infection with M leprae, but cases of leprosy continue to be reported in the US, and illness is of particular concern among immunocompromised individuals. Treatment delay is common because of the condition’s relative rarity in the US, but therapy with standard antibiotics is extremely effective. Lengthy isolation from family and community is not often needed, and relapses are rare. Fully restored health is the rule rather than the exception for patients treated for Hansen’s disease.