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Persistent plaques after release from treatment in slit-skin smear negative leprosy patients: Wait and watch or adopt
Tarun Narang1, Anuradha Bishnoi1, Vishal Thakur1
1Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract:
A subset of leprosy patients has clinical and histopathological activity in the form of persistent plaques and granulomas after completion of multidrug therapy (MDT) which can have significant impact on their quality of life. In the absence of clear guidelines regarding management of such patients, majority of the times they are treated either as late reversal reaction with corticosteroids or no active treatment is offered. We observed 11 patients of leprosy with persistent plaques after completing the 6/12-months MDT who were treated favorably with minocycline 100 mg once daily for 16 weeks. Complete clinical resolution was observed in 9/11 patients while two patients had partial improvement. Histopathological improvement in the form of disappearance of granulomas corroborated with the clinical improvement. All the patients tolerated the treatment well and hyperpigmentation was the only adverse effect noted. Minocycline may be considered as a useful and well tolerated therapeutic option for this subset of leprosy patients due to its immune modulatory and anti-inflammatory effects.
Insights
Minocycline effectively treated persistent leprosy plaques in 11 patients after multidrug therapy (MDT). Most patients achieved complete clinical and histopathological resolution with minimal side effects, suggesting minocycline as a viable treatment option.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Leprosy patients can experience persistent plaques and granulomas post-multidrug therapy (MDT).
- Current management lacks clear guidelines, often resulting in corticosteroid use for reversal reactions or no active treatment.
- This can negatively impact patients' quality of life.
Purpose of the Study:
- To evaluate the efficacy and tolerability of minocycline in treating persistent leprosy plaques after MDT completion.
- To explore minocycline's potential as an alternative therapeutic option for this patient subset.
Main Methods:
- Observational study of 11 leprosy patients with persistent plaques post-MDT.
- Treatment with minocycline 100 mg once daily for 16 weeks.
- Clinical assessment and histopathological examination for improvement.
Main Results:
- Complete clinical resolution in 9 out of 11 patients.
- Partial improvement in 2 patients.
- Histopathological evidence of granuloma disappearance correlated with clinical outcomes.
- Minocycline was well-tolerated, with hyperpigmentation as the sole adverse effect.
Conclusions:
- Minocycline demonstrates favorable efficacy and tolerability for persistent leprosy plaques post-MDT.
- Its immune modulatory and anti-inflammatory properties may contribute to its therapeutic effect.
- Minocycline offers a promising treatment option for this challenging leprosy patient group.
