# Leprosy (Hansen's Disease) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.06 - condition scope only, no dose · Leprosy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK559307/ · Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292) - Verified date: 2026-08 ## Verified against - Leprosy (Hansen's Disease) - disease-level clinical article (leprosy-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292) ## Treatment metadata - Dapsone — 100 mg — oral.solid - Rifampicin — 300 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text LEPROSY (HANSEN'S DISEASE) Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.06 - condition scope only, no dose · Leprosy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK559307/ · Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292) Review status: REVIEWED against Leprosy (Hansen's Disease) - disease-level clinical article (leprosy-clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Numbness and pins-and-needles sensations occur in the arms and legs [numbness · tingling] - Patients may sustain burns on the hands or feet without feeling pain - Fatigue, general malaise, and fever can occur during immune reaction episodes [fatigue · fever · malaise] - Sensory loss comes first in the nerve disease course, with pain sometimes developing later [numbness] - Nasal congestion resembling a common cold can occur with mucosal spread [blocked nose] - Sudden painful nodules on the limbs or face mark a type 2 reaction episode SIGNS - what you find (8) - A well-defined lesion with a pale centre and reduced sensation marks the tuberculoid pole of disease [numbness · pallor] - Reddish patches on the skin lose normal sensation [redness] - Earlobes may show lumps or swelling - Peripheral nerves can be felt as thickened on palpation - Advanced disease brings claw-hand deformity, facial droop, lost eyebrows and lashes, or a collapsed nasal septum [collapse · facial weakness · visible deformity] - Eyelid nerve loss can cause incomplete eye closure, corneal injury, and dryness - A type 1 flare shows red, swollen existing lesions with possible weakness or nerve loss around the trunk or face - Type 1 reaction findings include ulcerated lesions and loss of nerve function TESTS (6) - The WHO grades disease by lesion count: 5 or fewer with a negative smear is paucibacillary, 6 or more with a positive smear is multibacillary - Labs often show a high white cell count, low haemoglobin and haematocrit, raised liver enzymes, and raised CRP - Skin biopsy PCR for M. leprae is over 90% sensitive and 100% specific, dropping to 34% sensitivity in tuberculoid disease - The lepromin skin test is read 3 to 4 weeks after injection but has low predictive value even in endemic regions - PGL-1 serology is not sensitive enough for use without other clinical or biopsy evidence - Loss of light-touch and pinprick sensation within the lesion is the confirmatory clinical finding IF NOT THIS - what else fits (8) - Granuloma annulare has a scale-less plaque with a rope-like raised border and central clearing, typically at the wrists, hands, feet, or ankles - A dermatophyte skin infection has a scaling round patch with a raised erythematous edge and central clearing, confirmed on KOH prep - Annular psoriasis is tied to classic psoriatic plaques or nail disease and needs biopsy to confirm - Lupus can show a butterfly-shaped facial rash or a sun-triggered eruption on exposed skin - A keloid is a raised scar confined to and extending from the original wound site - Mycosis fungoides shows varied patches, tumours, erythroderma, and hair loss, confirmed by skin biopsy - Neurofibromatosis is marked by cafe-au-lait spots, axillary or groin freckling, and neurofibromas, diagnosed clinically - Cutaneous leishmaniasis starts as pink papules on exposed skin that grow into nodules then painless, indurated ulcers Source StatPearls "Leprosy" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Dapsone + Rifampicin Rx: Antibiotic | Main treatment ANTIBIOTIC - give all together 1. DAPSONE [1 of 2 - GIVE ALL TOGETHER] Adult 100 mg once daily, always with rifampicin (and with clofazimine in multibacillary disease) - WHO: 6 months paucibacillary, 12 months multibacillary. US National Hansen's Disease Program: 12 and 24 months Peds 1-2 mg/kg/dose [child max 100 mg] (THE TWO PROGRAMMES DIFFER, AND THE GRID SPANS BOTH. US National Hansen's Disease Program 2018: 1 mg/kg once daily, maximum 100 mg, for 12 months in paucibacillary disease. WHO 2016: children under 10 years and under 20 kg, 2 mg/kg once daily for 6 months; children 10 years and over and adolescents up to 14 years weighing 20-40 kg, a flat 25 mg once daily for 6 months. Both are given with rifampicin.) 3kg -> 3-6 mg/dose 4kg -> 4-8 mg/dose 5kg -> 5-10 mg/dose 6kg -> 6-12 mg/dose 7kg -> 7-14 mg/dose 8kg -> 8-16 mg/dose 9kg -> 9-18 mg/dose 10kg -> 10-20 mg/dose 11kg -> 11-22 mg/dose 12kg -> 12-24 mg/dose 13kg -> 13-26 mg/dose 14kg -> 14-28 mg/dose 15kg -> 15-30 mg/dose 16kg -> 16-32 mg/dose 17kg -> 17-34 mg/dose 18kg -> 18-36 mg/dose 19kg -> 19-38 mg/dose 20kg -> 20-40 mg/dose 21kg -> 21-42 mg/dose 22kg -> 22-44 mg/dose 23kg -> 23-46 mg/dose 24kg -> 24-48 mg/dose 25kg -> 25-50 mg/dose 26kg -> 26-52 mg/dose 27kg -> 27-54 mg/dose 28kg -> 28-56 mg/dose 29kg -> 29-58 mg/dose 30kg -> 30-60 mg/dose 31kg -> 31-62 mg/dose 32kg -> 32-64 mg/dose 33kg -> 33-66 mg/dose 34kg -> 34-68 mg/dose 35kg -> 35-70 mg/dose 36kg -> 36-72 mg/dose 37kg -> 37-74 mg/dose 38kg -> 38-76 mg/dose 39kg -> 39-78 mg/dose 40kg -> 40-80 mg/dose 41kg -> 41-82 mg/dose 42kg -> 42-84 mg/dose 43kg -> 43-86 mg/dose 44kg -> 44-88 mg/dose 45kg -> 45-90 mg/dose 46kg -> 46-92 mg/dose 47kg -> 47-94 mg/dose 48kg -> 48-96 mg/dose 49kg -> 49-98 mg/dose 50kg -> 50-100 mg/dose Choice Alternatives. Dapsone and rifampicin together are the backbone of every leprosy regimen; clofazimine is added for multibacillary disease and is not stocked in Egypt through normal channels. Source Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292) Why The formulary's first listed indication for dapsone is treatment of leprosy due to susceptible strains of Mycobacterium leprae, and its dosing paragraph gives both regimens side by side - the WHO's and the US National Hansen's Disease Program's - which differ only in how long treatment runs. Never given alone: the formulary and the disease article both state that multidrug therapy is what prevents resistance, and resistance to dapsone monotherapy is documented history, not theory. Caution TREAT THROUGH THE NATIONAL PROGRAMME, NOT FROM A REFERENCE ENTRY. The formulary itself says treatment should be managed in consultation with a leprosy expert. Leprosy is notifiable; contacts need tracing and the regimen runs for 6 to 24 months. CLOFAZIMINE, THE THIRD DRUG IN MULTIBACILLARY DISEASE, IS NOT IN THE EGYPTIAN FORMULARY. The disease article gives it as 50 mg daily. It has to be obtained through the programme. Dapsone causes haemolysis, and severely so in G6PD deficiency - common in Egypt. Check before starting and watch the haemoglobin. Do not give to anyone with a known allergy to dapsone. Nerve damage, not the skin patch, is what disables. Reactions during treatment (type 1 and type 2) need urgent specialist care, not a change of antibiotic. Egypt DAPSONE 100MG 20 TABS. EL NILE. 158.00 EGP (7.90/unit) 2. RIFAMPICIN [2 of 2 - GIVE ALL TOGETHER] Adult 600 mg daily, with dapsone x 12 months for tuberculoid disease; 24 months for lepromatous disease, with clofazimine Peds No paediatric leprosy dose for rifampicin appears in the Egyptian formulary, because its rifampicin monograph does not cover leprosy at all. A child's regimen must come from the national leprosy programme. Source Leprosy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK559307/ Why The cited disease article gives the regimens directly: tuberculoid disease, dapsone 100 mg daily with rifampicin 600 mg daily for 12 months; lepromatous disease, dapsone, rifampicin and clofazimine 50 mg daily for 24 months. The dose is cited to that article and not to the formulary for a reason worth stating plainly: the Egyptian formulary's rifampicin monograph lists only tuberculosis and meningococcal carriage as indications, so it does not answer for leprosy. What the formulary does confirm is the pairing - its dapsone monograph names rifampin as the drug dapsone is combined with in every leprosy regimen it gives. Caution TREAT THROUGH THE NATIONAL PROGRAMME. Leprosy is notifiable and the regimen runs for a year or two; this is not a prescription to start and review in a fortnight. Rifampicin turns urine, tears and sweat orange, and stains soft contact lenses permanently. Warn the patient or they will stop the drug. It is a powerful enzyme inducer: it makes the combined oral contraceptive pill fail, and it lowers the level of many other drugs. Check every co-prescription. The formulary bars it in liver impairment, in jaundice from reduced bilirubin excretion, in premature and newborn infants, and in breastfeeding women, and it must not be combined with praziquantel, atazanavir, darunavir, fosamprenavir, ritonavir/saquinavir, saquinavir or tipranavir. Watch liver function. Hepatitis is the adverse effect that stops treatment. Egypt RIFAMPIN 300MG 10 CAPS. ARAB CAPS 8.00 EGP (0.80/unit) RIFABIOTIC 300 MG 8 CAPS. CID 8.00 EGP (1.00/unit) RIFAMPICIN 300MG 8 CAPS. EL NASR 9.50 EGP (1.19/unit) RIFAMPIN 300MG 8 CAPS (MISR) MISR 9.50 EGP (1.19/unit) RIMACTANE 300MG 8 CAPS. NOVARTIS 10.10 EGP (1.26/unit) RIFAMPIN 300MG 10 CAPS. (DEBEIKY) DEBEIKY 38.50 EGP (3.85/unit) RIFACTINE 300 MG 8 CAPS. MUP 31.00 EGP (3.88/unit) RIFAMOX 100MG/5ML 30GM SUSP. EL NASR 4.50 EGP -> ? strength differs, ? different route - not oral solid RIFAM 100MG/5ML 60ML SUSP. PHARCO 7.00 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Chronic mycobacterial infection of skin and peripheral nerves. Egypt has reached WHO elimination thresholds but sporadic cases still occur, mostly in Upper Egypt/Delta foci, so a GP should recognise a suspicious hypopigmented anaesthetic patch or thickened nerve and refer to the national leprosy control programme, which supplies multidrug therapy free of charge rather than the GP prescribing it. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Chronic mycobacterial infection of skin and peripheral nerves. Egypt has reached WHO elimination thresholds but sporadic cases still occur, mostly in Upper Egypt/Delta foci, so a GP should recognise a suspicious hypopigmented anaesthetic patch or thickened nerve and refer to the national leprosy control programme, which supplies multidrug therapy free of charge rather than the GP prescribing it. Caution Rare in Egyptian primary care. The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral. RED FLAG - Severe neuritis (leprosy immunologic reaction) is a medical emergency needing immediate corticosteroid treatment to prevent irreversible nerve damage. RED FLAG - Nerve abscess (most often the ulnar nerve) requires immediate surgical intervention to prevent irreversible sequelae. RED FLAG - An anaesthetic skin patch with a thickened peripheral nerve needs referral for a skin smear or biopsy, and sudden nerve pain or new weakness (a leprosy reaction or neuritis) needs urgent referral to prevent permanent nerve damage. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)