Treatment of Hansen’s Disease (Leprosy)

Abstract

Purpose of review

Because leprosy (Hansen's Disease, HD) is rare, details of treatment of this infection and of its complications are not familiar to many physicians. The basic treatment of Mycobacterium leprae infection, prevention of associated disabilities, and management of its complications have therefore been reviewed.

Recent findings

Multi-drug therapy (MDT) for HD is highly effective, but lengthy (12–24 months). Drug resistance and relapse of infection are rare. New anti-mycobacterial agents are being tested to try to reduce the duration of treatment. The major challenge in HD is the management of immunologically mediated complications called reactions, and of the neuritis and neuropathy that may result. Reactions are often perceived—incorrectly—as "treatment failure," relapse, or an adverse drug reaction. They occur before, during, or after completion of MDT, triggered by M. leprae antigens. Reactions are medical emergencies because they can precipitate severe, rapid peripheral nerve injury.

Summary

Anti-mycobacterial treatment of HD is highly successful; shortening the duration of treatment is a major goal. Reactions require prompt treatment with moderate to high doses of corticosteroids. One type of reaction (ENL) responds to thalidomide, but this is expensive and can induce severe birth defects. Other immunosuppressive agents are being studied for their benefit in managing reactions. Basic and clinical research are focused upon developing short-duration drug regimens, improving treatment of reactions, and preventing or limiting nerve injury.

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