(LML) Erythematous itchy rash after 3rd dose of MDT MB

Leprosy Mailing List – November 6,  2016

Ref.: (LML) Erythematous itchy rash after 3rd dose of MDT MB

From: P Vijayakumaran, Vellore, India

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Dear Dr. Schreuder,

 

 

I had come across similar situations (see LML letter Dr. Nepali, October 30, 2016) in Karigiri. For example I diagnosed a MB patient with a leprosy reaction. I started MDT and steroids. When the dose of steroid was tapered off, signs of dapsone hypersensitivity (skin rashes) appeared. It was not severe because the person was still on lower dose of steroid. I feel that steroid may mask the serious manifestation of drug reaction. I suggest to consider this possibility.

 

With best wishes,

 

Dr.P.Vijayakumaran,

Consultant Leprologist,

Vellore, Tamilnadu, India

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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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(LML) Erythematous itchy rash after 3rd dose of MDT MB

 Leprosy Mailing List – November 6,  2016

Ref.: (LML) Erythematous itchy rash after 3rd dose of MDT MB

From: Wim Brandsma, Pokhara, Nepal

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Dear Pieter,

I would like to refer to the letter by Dr. Nepal Nepali of October 30, 2016 and the response by Ben Naafs of October 31, 2016

I always suggest to the staff of Green Pastures (Pohkara, Nepal) that when they are encountering problems with leprosy they cannot solve, they should raise the question with LML. That is an important way to improve leprosy care in the field.

Regards,

Wim Brandsma

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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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(LML) A day on the ground

Leprosy Mailing List – November 1,  2016

Ref.: (LML) A day on the ground

From:  Grace Warren, Sidney, Australia

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Dear Pieter,

 

I would love to congratulate Joel Almeida on the letter regarding the diagnosis of leprosy (LML, October 31, 2016).  Working in Hong Kong and Taiwan in the 1960s I saw many patients who did not have the classical  "Anesthetic skin patch" that WHO states is essential for the diagnosis of leprosy.

 

Yes many of our patients had skin that was obviously infiltrated on palpation, but there was no obvious patch and no altered sensation - only on slit skin smear we were able to definitely diagnose leprosy.  They of course would be highly infectious and at an ideal time to start treatment.   

 

Also I have often seen many present with a foot drop or a partly clawed hand and no other complaints but on careful examination we often found there were enlarged nerves in the affected area and often some altered sensory perception.

 

I have been disturbed for many years regarding the lack of training of medical students. I have worked in many South Asian countries and lectured in medical colleges. In one endemic country I lectured in every medical college and was often told it was the first lecture on leprosy in that college!!!!.  Yes I agree with Joel Almeida we need to have better trained personnel looking for the patients and able to assess the suspects; and ideally to check the contacts of those who could be spreading the disease.   How can we influence those concerned to improve early diagnosis in order to really control this problem.

 

I am so often greeted by the comment  "But there is no leprosy today" and the speakers are horrified when I tell them that " leprosy is present in every country of the world if you look for it ". How can we spread the information needed to enable us to find those who do need the full treatment?  Also how can we get the older medical personnel to look for leprosy when they have never really learnt how to do it?

 

Yours sincerely,

 

Grace Warren

Previously  Medical Superintendent of the Hong Kong Leprosarium in 1960s and Travelling Consultant in leprosy and  Rehabilitation Surgery for the Leprosy Mission in Asia 1975-1990

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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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(LML) Erythematous itchy rash after 3rd dose of MDT MB

Leprosy Mailing List – November 1,  2016

Ref.: (LML) Erythematous itchy rash after 3rd dose of MDT MB

From:  Narasimha Rao, Hyderabad, India

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Dear Pieter, 

 

 

I strongly suspect the diagnosis of Dapsone hypersensitivity syndrome in this patient (LML, October 30, 2016). It can occur from 3 weeks to 3 months of starting therapy. The course already suggested by Ben Naafs is very practical (LML, October 31, 2016).

 

With best regards,

 

P Narasimha Rao 

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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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(LML) A day on the ground

Leprosy Mailing List – October 31,  2016

Ref.: (LML) A day on the ground

From: Joel Almeida, Mumbay and London

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Dear Pieter,

 

 

What active case-finding is like on the ground:

 

http://indianexpress.com/article/india/india-news-india/watch-for-the-patch-a-day-in-the-life-of-a-leprosy-detection-team-in-maharashtra-3729337/#i-74075524-2B05-4EFC-A52A-223280F2E1B4

 

An infectious case lies buried like a needle in a haystack of transient, self-limiting cases. Skin smears allow such patients to be identified. Many have no signs other than subtle induration of the skin.

 

One untreated patient with polar lepromatous leprosy can shed more M. leprae than do hundreds of thousands of patients with self-limiting disease. 

 

Polar lepromatous patients may be previously untreated, or re-infected after release from MDT. It is a serious error to deny them skin smears, or anti-microbial treatment. This error is sufficient to defeat leprosy control efforts, including chemoprophylaxis. 

 

Trained and skilled leprosy workers are indispensable. Especially for detecting and treating the silent neuritis which causes 85% of permanent nerve damage in South Asian populations. As many as 90% of patients regain nerve function with anti-inflammatory treatment: if, and only if, nerve damage is detected promptly.  It is a serious error to deprive patients of mobile, trained and skilled leprosy workers.

 

It is good that we are discarding past errors to launch a new era of leprosy control. One based on close acquaintance with clues from the ground, and greater respect for the nerves of individual patients.

 

This new era enables us to rebuild timely access to high-quality leprosy services. We have been destroyers of services for long enough. Now we can become builders once again. That's how we will succeed.

 

 

Joel Almeida

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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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(LML) Erythematous itchy rash after 3rd dose of MDT MB

Leprosy Mailing List – October 31,  2016

Ref.: (LML) Erythematous itchy rash after 3rd dose of MDT MB

From: Ben Naafs, Munnesburen, the Netherlands

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Dear Pieter,

 

I would like to refer to the letter by Dr. Nepal Nepali of October 30, 2016:

I understand that it is itchy. It does look urticarial with a vasculitis component. It could be a drug eruption or just a passing urticarial reaction due to anything. The risk is that it is the start of a dapsone syndrome which happens often in Nepali. This is a DRESS syndrome (Drug eruption with generalized symptoms). At least stop dapsone (and possibly also rifa) immediately and give steroids and antihistamines. Look for liver function and haemogram blood tests.  There must be a Nepali protocol how to react in case of suspect dapsone syndrome!

If it is not dapsone, it can be any of the other drugs. I would continue the clofazimine. After the clinical picture (and lab. tests) becomes quite, introduce first the rifa, see what happens, then (under close supervision) the dapsone. In the meantime give antihistaminics.

 

Regards,

 

Dr Ben Naafs

 

 

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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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(LML) Erythematous itchy rash after 3rd dose of MDT MB

 

Leprosy Mailing List – October 30,  2016

Ref.: (LML) Erythematous itchy rash after 3rd dose of MDT MB

From: Nepal Nepali, Nepal

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Dear Dr. Schreuder,

 

I work at a leprosy hospital in Nepal and would like your opinion on the following case:

Woman, 38yrs old, diagnosed with MBHD 3 months ago. We started MDT MB. Recently she received her 3rd monthly dose of Rifampicin, and Clofazamine. She now presented with generalized erythematous itchy rash all over her body (see attached file).

How should I manage this patient?

Regards,

Nepal Nepali

 

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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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