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LEPROSY

Bambang SuhariyantoLab/ SMF. I.K.Kulit & Kelamin

FK. UNEJ/ RSUD. Dr.SoebandiJember

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G.N.A HANSEN (1873)

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How to diagnose and treat

leprosy?

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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

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How to diagnose leprosy

Examine skin

Check for patches

Test for sensation Count the number

of patches

Look for damage

to nerves

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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

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Leprosy patches...

. Can be pale, reddish orcopper coloured

. Lack sensation to pain,

touch and heat

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Leprosy patches ...

can be flat or raised

do not itch

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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

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Classification of leprosy

PB MBSkin Lesion 2 to 5 > 5

Nerve Trunk One 2 to 5

Skin Smear Negative Negative or positive

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Treating a patient with WHO MDT

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Classification for treatment

Leprosy is diagnosed on finding a

definite loss of sensation in one or more

patches

When you have examined the wholebody, count the number of patches

1-5 patches is

paucibacillary (PB)

leprosy

More than 5 patches is

multibacillary (MB)

leprosy

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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 takenonce a month and every day

Explain possible side effects (e.g. Darkening of skin) andpossible complications and when they must return tothe health centre

Ask the patient when it is convenient for him/her to

come back to the health centre. Give enough MDTblister packs to last until the next visit.

Fill out the patient treatment card

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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 amonth

Clofazimine 300 mg once

a month

Clofazimine 50 mg and

dapsone 100 mg every

day

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MDT side-effects

Red coloured urine

Darkening of skin

Severe itching of skin

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IDENTITAS PENDERITA

Nama : Ny. S

No RM : 138471

Jenis kelamin : Perempuan

Umur : 35 tahun

Status : Menikah

Pekerjaan : Ibu Rumah Tangga Alamat : Lumajang

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RESUME

Px perempuan, 35 tahun dg keluhan sejak 1 th yll muncul bercakkemerahan di pipi kiri salep oleh mantri tidakberkurang/menghilang, hanya warnanya menjadi tdk begitumerah. Karena tdk ada keluhan lainnya, maka bercak tersebutdibiarkan saja. Beberapa bln kemudian, muncul bercak2 di

kaki dg ukuran yg lebih kecil dbd bercak di wajah, tidak gataldan tidak nyeri berobat ke Puskesmas dan dikatakanalergi.

5 bln kemudian muncul bercak lagi di tangan dan di dada, tidakgatal, tidak nyeri. 3 bln kemudian px merasa tangannyabengkak dan saat dicubit sering tdk terasa sakit. Namun halini dibiarkan saja. Px merasa badannya terus lemah dansering gringgingan terutama di kaki dan tangan.

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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 > 5th.

Pmx fisik lesi: > 5, efluoresensi: macula hiperpigmentasi,

hipoanestesi, ukuran lentikuler-numuler, 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%.

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DIAGNOSIS BANDING

1. Drug Eruption

2. Dermatitis Alergica

DIAGNOSIS KERJA

Kusta Tipe Multi basiler (LL)

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silahkan bertanya

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