Leprosy Mailing List – January 19, 2020
Ref.: (LML) Dapsone allergy and MB treatment
From: Arry Pongtiku, Papua, Indonesia
Dear Pieter,
I could not avoid myself not to comment about Dapsone allergy posting by Dr. Shen Jianping and replying by Dr.B Naafs. I have already few times posted issues about the Dapsone allergy (DHS). Last year I shared in this leprosy mailing list a short paper about " Epidemiological Dapsone hypersensitivity syndromes among leprosy patients in Indonesia and its black box".
Dapsone Hypersensitive Syndrome /DHS is a sorrow behind MDT successful stories.
Papua and Papua Barat, eastern provinces of Indonesia have high incidences of Dapsone allergy. Some spots of high incidences of DHS (more than 1%) and remote areas we have a local policy to remove Dapsone from blister for MB treatment since 2007 (but already practiced some years before that).
As we are aware of Dapsone allergy it is an important topic when we gave leprosy training. Dapsone allergy often occurred after completion of the first blister of MDT with mild symptoms: dry skin, itchy, feels hot burning, arise rashes, headache, watery eyes. Severe symptoms: dry cough, shortness of breath, flaky skin (dermatitis exfoliativa), sore on the lips, mouth, jaundice. Dapsone allergy is not infrequently fatal where people/medical staff less aware. In the cases of Dapsone allergy, MDT must be stopped and give immediate prednisolone treatment. Administration of prednisolone should be slowly tapering off, practically completed about 1.5 months.
My experience also those who are already allergic but we forgot when to take dapsone or sulfone derivate for the second time the onset will be shorter and dangerous.
More than 10 years of observation, I felt 2 drugs (Rifampicin and clofazimine) were enough for MB treatment for those with allergy. However, in the last 5 years, I also found some cases of those who complete treatment clinically relapsed. I also think maybe caused by insufficient drugs or reinfection.
I remember one spot of leprosy in very remote areas in 2013 (60% of tribal population in remote areas got leprosy) they would remove dapsone for treatment, I insisted to give full of treatment of MDT because of hyperendemic leprosy. Those who have no symptoms we give blanket chemoprophylaxis with single rifampicin. It was successful and no case was diagnosed anymore.
Minocycline and ofloxacin are not available in the program in Indonesia and difficult to find.
Together with Nalagenetic Singapore and National Research Indonesian Institute in 2016-2017, I involved in taking samples of those who suffered from Dapsone allergy in Papua and Papua Barat, they were all confirmed positive for the biomolecular test.
Thank you very much,
Best Wishes,
Arry Pongtiku (Papua, Indonesia)
Former National Leprosy Adviser/ Netherlands Leprosy Relief: 2006-2016
Until now practicing for leprosy
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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