If the patient presents with nodules and plaques, you’ll need to consider sarcoidosis, lymphoma, cutaneous tuberculosis, syphilis, leishmaniasis, and cutaneous systemic mycosis.2
Biopsy clinches the diagnosis
Leprosy lesions characteristically develop in cooler regions of the body and may include macules, papules, nodules, or plaques.2 Temperature sensation is typically the first to be affected by leprosy, followed by touch, pain, and then pressure perception.2 The diagnosis of leprosy is confirmed with skin biopsy.2
A multidrug approach to the treatment of leprosy
The incidence of sulfone antibiotic resistance is increasing; therefore patients with leprosy should be treated with more than 1 drug.5 Standard therapy for leprosy involves rifampin 600 mg daily, dapsone 100 mg daily, and in multibacillary disease, clofazimine 50 mg daily5 (strength of recommendation [SOR]: B). Patients are classified as paucibacillary if they have 1 to 5 skin lesions, and multibacillary if they have more than 5 lesions.6 Other antibiotics used in the treatment of leprosy include ofloxacin, clarithromycin, levofloxacin, and minocycline5 (SOR: B).
Compared with other infectious diseases, such as pulmonary Mycobacterium tuberculosis, leprosy is far less contagious; 95% of the human population has immunity to the disease.5
Our patient received a 3-drug regimen
We reported our patient’s case of leprosy to the Texas Department of Health as well as the National Hansen’s Disease Center. He began treatment shortly after diagnosis at a regional center for Hansen’s disease in San Antonio. He was treated with rifampin, clofazimine, and dapsone, and his lesions improved.
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
CORRESPONDENCE John M. Martin IV, MD, 7703 Floyd Curl Drive, Dental Building 5.318T Mail Code 7876, San Antonio, TX 78229; johnmartin334@yahoo.com