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Hansen: Sơ Đ
Hansen: Sơ Đ
TABLE 14-1
MODIFIED RIDLEY-JOPLING CLASSIFICATION FOR LEPROSY
Characteristics of Lesions
Stage of Disease Number Size Surface Sensation* Hair Growth
Polar lepromatous Very many Small Shiny Not affected Not affected
(LLp)
Subpolar lepromatous Very many Small Shiny Not affected Not affected
(LLs)
Borderline lepromatous Many Variable Slightly shiny Slightly diminished Slightly diminished
(BL)
Borderline borderline Several Variable Dry Slightly to moderately Moderately diminished
(BB) diminished
Borderline tuberculoid Few or 1 Variable Dry Moderately to Moderately diminished
(BT) markedly diminished
Subpolar tuberculoid Usually 1 Variable Very dry Absent Absent
(TTs)
Polar tuberculoid Usually 1 Variable Very dry Absent Absent
(TTp)
334
Leprosy
Spontaneous
Healing > 99%
Polar
Tuberculoid
Leprosy = TTp
75%
Borderline
Tuberculoid
Leprosy = BT
Exposure to Borderline
Leprosy Borderline
Bacillus Leprosy = BB
Subclinical Indeterminate 25%
Infection 0.5% Leprosy = IL
Borderline
Lepromatous
Leprosy = BL
Polar
Lepromatous
Leprosy = LLp
Fig. 14-4. The pathogenesis of leprosy. Exposure usually
results in spontaneous healing. Subclinical infection
progresses to indeterminate leprosy, which spontane-
Lucio's Diffuse
ously remits in 75% of patients; however, in 25% of
Lepromatous
patients, the disease progresses to one of the more seri- Leprosy = LLp
ous forms of leprosy.
Very many (plus globi) Very many (plus globi) 5–6 Negative Polar lepromatous leprosy
Very many (plus globi) Very many (plus globi) 5–6 Negative Downgraded to LL from BL due
to lack of therapy
Many Usually nil 4–5 Negative Unstable immunity
335
Military Dermatology
600 mg in adults
Rifampin
supervised, (450 mg < 35 kg)
1 dose/mo • 6
Paucibacillary 10 mg/kg in
Disease children
100 mg in adults
Plus Dapsone,
unsupervised OK,
daily for 6 mo
1–2 mg/kg in
children
600 mg in adults
Rifampin,
Treatment
supervised,
Of
1 dose/mo for
Leprosy
≥ 24 mo
10 mg/kg in
children
100 mg in adults
Plus Dapsone,
unsupervised OK,
daily for ≥ 24 mo
Multibacillary 1–2 mg/kg in
Disease children
Supervised,
300 mg in adults,
1 dose/mo for
≥ 24 mo
Plus
unsupervised,
Plus Clofazimine
50 mg daily for
≥ 24 mo
Children,
1–2 mg/kg for
both monthly and
daily doses
Fig. 14-13. World Health Organization guidelines for the treatment of uncomplicated leprosy. Data source: WHO
Expert Committee on Leprosy. World Health Organization Technical Report Series 768. 6th report. Geneva, Switzerland:
World Health Organization; 1988.
344
Leprosy
Polar
Tuberculoid
Leprosy = TTp
Subpolar
Tuberculoid
Leprosy = TTs
Borderline
Tuberculoid
Leprosy = BT
Borderline
Borderline
Leprosy = BB
Downgrading
Indeterminate
Leprosy = IL
Reversal
Borderline
Lepromatous
Leprosy = BL
Subpolar Erythema
Lepromatous Nodosum
Leprosy = LLs Leprosum (rare)
Polar Erythema
Lepromatous Nodosum
Leprosy = LLp Leprosum
Fig. 14-15. The possible reactional states in leprosy: reversal reaction, also called Type 1 (red); erythema nodosum
leprosum, also called Type 2 (blue); downgrading reaction (green); and Lucio’s phenomenon (yellow). Note that
erythema nodosum leprosum can occur via three pathways.
347
Leprosy
Prednisone
40–80 mg/d
with taper over
3–6 mo
Thalidomide
not useful
Analgesics (ie,
aspirin)
Mild reactions
Chloroquin,
Antimonials
(Stibophen)
Prednisone
40–80 mg/d
With neuritis
tapering slowly
over months
Acute reactions
Prednisone
Without neuritis 40–80 mg/d,
quick taper
Type 2: possible
Treatment of Erythema
Reactional Nodosum
States Leprosum Drug of choice
in relapses and
chronic cases
Thalidomide
100 mg qid,
taper over
few weeks
Contraindicated
in pregnant
females
Chronic
reactions and
relapses
Clofazimine 100 Slow onset, may
mg tid 4–6 wk, be used in
bid for months pregnancy
May be used in
Prednisone pregnancy
Prednisone
Lucio’s
Phenomenon
Dapsone
plus
Rifampin
349