(LML) Erythematous itchy rash and Dapsone hypersensitivity

Leprosy Mailing List – November 17,  2016

Ref.:    (LML) Erythematous itchy rash and Dapsone hypersensitivity

From:  Arry Pongtiku, Irian Jaya, Indonesia

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Dear Pieter,

Thank you for sharing about erythematous itchy rash from dr Nepal Nepali and comments from dr Ben Naafs. I would say that I have been working as leprosy adviser in Papua and West Papua for 10 years. Those places have the highest incidence of DDS allergy, Dapsone hypersensitivity in Indonesia. I have seen many cases. Dapsone hypersensitivity is a very important topic in our teaching and on the job training; if diagnosed late can be fatal. We have helped many patients as such.

 

To diagnose of Dapsone hypersensitivity, there are some practical things:

-History of taking MDT for fist to second blister packs

-Some clinical signs as follows:

1. Symptoms of mild (early)
- The skin feels dry
- Itchy Skin
- Skin feels hot burning
- Arise rashes
- Headache
- Watery eyes
2. Severe symptoms usually appear after 24-48 hours after taking Dapsone or after the early symptoms arise.
 - Lips / thick face
- Embossed red spots that itch and heat
- Fever even to high heat
- Dry cough, sometimes accompanied by shortness of breath
- Flaky skin (dermatitis exfoliative), sometimes accompanied by sores on the lips and in the  mouth
- The enlargement of the gland
- The eye (conjunctiva) to yellow

 

In such cases stop MDT immediately if DDS allergy happened more details in attachment. Give immediately give prednisolone and tapering off not in hurry (please kindly find in attachment)

Any drug contains: sulfone such as Trisulfa, Fansidar (Trimetropin Pyrementamin/anti malaria), Cotrimoxasole not allowed for people who have history of allergy DDS

* if we use only Rifampicin and lamprene for DDS allergy sometimes relapse happened

I have seen in August 2016, there was an AIDS patient who received Cotrimoxazole, the clinical appearance was like Dapsone hypersensitivity of leprosy - learning from leprosy to AIDS

Thank you very much, May God bless you
salam,

 

Arry Pongtiku

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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