Am Fam Physician. 2002 Apr 1;65(7):1280-1281.
to the editor: I enjoyed the article about annular lesions.1 Although Hansen's disease is an unusual problem for most physicians in the United States, it should be noted that the recommended treatment has been revised.
The World Health Organization recommends2 that paucibacillary persons receive 600 mgof rifampin (Rifadin) monthly and 100 mg of dapsone daily for six months. For multi-bacillary persons, treatment is 600 mg of rifampin plus 300 mg of clofazimine (Lamprene) monthly, in addition to 100 mg of dapsone plus 50 mg of clofazimine daily—all to be taken for 12 months. Persons with single-skin-lesion, paucibacillary leprosy can be treated with a single dose of rifampin, ofloxacin (Floxin), and minacycline (Minocin).3,4
In the United States, one recommended treatment for persons with paucibacillary disease is 100 mg of dapsone plus 600 mg of rifampin daily for 12 months. For multibacillary disease, treatment consists of 100 mg of dapsone, 600 mg of rifampin, and 50 mg of clofazimine daily for 24 months, or the standard WHO regimen.2 Treatment is usually instituted by a physician experienced in the management of the complications of Hansen's disease.
1. Hsu S, Le EH, Khoshevis MR. Differential diagnosis of annular lesions. Am Fam Physician. 2001;64:289–96.
2. Ooi WW, Moschella SL. Update on leprosy inimmigrants in the United States: status in the year 2000. Clin Infect Dis. 2001;32:930–7.
3. Jacobson RR, Krahenbuhl JL. Leprosy. Lancet. 1999;353:655–60.
4. Style A. Early diagnosis and treatment of leprosyin the United States. Am Fam Physician. 1995;52:172–8.
in reply: A discussion of the treatment of Hansen's disease was beyond the scope of the article. We thank Dr. Alto for his detailed update.
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