LEPROSY

Bambang Suhariyanto
Lab/ SMF. I.K.Kulit & Kelamin
FK. UNEJ/ RSUD. Dr.Soebandi
Jember

G.N.A HANSEN (1873)

How to diagnose and treat

leprosy?

How to examine for leprosy?

Examine in a well-lit room
Examine the whole body
Ask since when the patch was
noticed
Ask what treatments have been
tried
Test for sensation
Look for any visible deformities

How to diagnose leprosy

Examine skin
Check for
patches
Test for
sensation
Count the
number
of patches
Look for

Signs of leprosy
Pale or slightly reddish patch
Definite loss of sensation in the patch
Signs of damage to nerves
definite loss of sensation in hands/feet
weakness of muscles of
hands/feet/face
visible deformity of hands/feet/face

Leprosy patches...

. Can be pale, reddish

or
copper coloured
. Lack sensation to
pain,
touch and heat

Leprosy patches ...

can be flat or
raised
do not itch

Check for loss of sensation

Take a pointed soft
object (feather,
cotton
wick)
Lightly touch
alternately
the patch and normal
skin
Ask the person to
point
where they were
touched

What is not leprosy

Skin patches which
have normal feeling
are present from birth
cause itching
are white, black, dark red or silver
coloured
show scaling
appear and disappear periodically
spread quickly

Classification of leprosy

PB

MB

Skin Lesion

2 to 5

>5

Nerve Trunk

One

2 to 5

Skin Smear

Negative

Negative or
positive

Treating a patient with WHO

MDT

Classification for treatment

Leprosy is diagnosed on finding a
definite loss of sensation in one or more
patches
When you have examined the whole
body, count the number of patches

1-5 patches is
paucibacillary
(PB)
leprosy

More than 5 patches

is
multibacillary (MB)
leprosy

Steps to start MDT

Classify as PB or MB leprosy
Inform the patient about the disease
Explain the MDT blister pack - show drugs to
be taken once a month and every day
Explain possible side effects (e.g. Darkening
of skin) and possible complications and
when they must return to the health centre
Ask the patient when it is convenient for
him/her to come back to the health centre.
Give enough MDT blister packs to last until
the next visit.
Fill out the patient treatment card

Treatment regimens
PB Adult
(Treatment: 6 blister
packs)
Rifampicin 600 mg
once a
month
Dapsone 100 mg
every
day
MB Adult
(Treatment: 12 blister packs)
Rifampicin 600 mg once a
month
Clofazimine 300 mg once
a month
Clofazimine 50 mg and
dapsone 100 mg every
day

MDT side-effects
Red coloured urine
Darkening of skin
Severe itching of skin

IDENTITAS PENDERITA

Nama : Ny. S
No RM : 138471
Jenis kelamin
: Perempuan
Umur : 35 tahun
Status : Menikah
Pekerjaan : Ibu Rumah Tangga
Alamat: Lumajang

RESUME
Px perempuan, 35 tahun dg keluhan sejak 1 th yll
muncul bercak kemerahan di pipi kiri salep oleh
mantri tidak berkurang/menghilang, hanya
warnanya menjadi tdk begitu merah. Karena tdk
ada keluhan lainnya, maka bercak tersebut
dibiarkan saja. Beberapa bln kemudian, muncul
bercak2 di kaki dg ukuran yg lebih kecil dbd
bercak di wajah, tidak gatal dan tidak nyeri
berobat ke Puskesmas dan dikatakan alergi.
5 bln kemudian muncul bercak lagi di tangan dan di
dada, tidak gatal, tidak nyeri. 3 bln kemudian px
merasa tangannya bengkak dan saat dicubit
sering tdk terasa sakit. Namun hal ini dibiarkan
saja. Px merasa badannya terus lemah dan sering
gringgingan terutama di kaki dan tangan.

Bbrp mgg yll px merasa alisnya lebih tipis dari biasanya,

bentuk hidungnya berubah berobat ke RS dr.
Soebandi. Sebelumnya tdk pernah menderita penyakit
spt ini. Namun px mengatakan pernah kontak dg px
kusta (tetangga dekat), 10 th yll. Kontak selama > 5
th.
Pmx fisik lesi: > 5, efluoresensi: macula
hiperpigmentasi, hipoanestesi, ukuran lentikulernumuler, bulat - lonjong, batas tegas, simetris bilateral,
pinggir eritematous, terdistribusi scr general di regio
fasialis didapatkan pula nodul simetris pd regio torakal
dan ekstremitas superior dan inferior. Madarosis (+),
saddle nose (+) dan fascies leonina (+) serta infiltrasi
di kedua lobulus auricula. Pada pmx saraf: penebalan
N. Auricularis Magnus D/S, g3 sensasi raba didalam dan
luar lesi, g3 sensasi nyeri di dalam lesi. Kulit terlihat
iktiosis dan oedema di keempat ekstremitas. Kekuatan
motoris sedang. Pemeriksaan lab: BI +3 dan MI 70%.

DIAGNOSIS BANDING
1. Drug Eruption
2. Dermatitis Alergica

DIAGNOSIS KERJA
Kusta Tipe Multi basiler (LL)

PLANNING
1. Medikamentosa
(MDT-MB 12-18 bln)
Sebulan sekali di bawah
pengawasan
# Rifampisin
: 2 x 300
mg
# Lamprene
: 3 x 100
mg
# DDS
: 1 x 100 mg
-Hari ke2 - 28
# Lamprene
: 1 x 50
mg
# DDS
: 1 x 100 mg

2. KIE
- Penyakit ini dpd disembuhkan,
ttp pengobatan lama (11,5
th), tidak boleh putus obat.
- Jika dalam masa pengobatan,
tiba-tiba badan px demam,
nyeri seluruh tubuh, disaertai
bercak2
memerah,

mencari pertolongan medis.

-Penyakit ini mengganggu saraf
mungkin terjadi kecacatan
jika
tdk
ada
tindakan
pencegahan.
Pencegahan
dilakukan
pada
jari-jari
tangan dan kaki yang kaku

silahkan bertanya