A patient with leprosy had slightly erythematous, anesthetic plaques on the trunk and upper limbs. He was treated with paucibacillary multidrug therapy (PB-MDT) for 6 months. At the end of 6 months, he had persistent erythema and induration in the plaque. The next step of action recommended by the World Health Organization (WHO) in such a patient is –
WHO recommends that
In paucibacillary leprosy, the multidrug therapy is stopped after 6 months of treatment regardless of the presence of clinically active disease".
According to Indian leprologists
"The t/t with both Rifampicin and dapsone must be continued till all signs of activity have been subsided".It is believed that these patients are virtually always cleared of viable bacteria in 6 months with the WHO-MDT regimen.Therefore the attainment of clinical inactivity should not be the condition guiding the continuation of multidrug therapy in paucibacillary leprosy.
The lesions may be present but they will be cleared of all the organisms.
The clinical activity does not correlate with bacterial multiplication.
Incidence of relapse in paucibacillary patients is very low and follow up studies in paucibacillary patients demonstrates that complete clearing of lesions takes 1-2 years after treatment discontinuation.
Stop antileprosy treatment
Continue PB-MDT till erythema subsides
Biopsy the lesion to document activity
Continue dapsone