Dermat ppt
- 2. Leprosy, caused by Mycobacterium leprae ,has been considered incurable since ages and bears a social stigma . Due to the availability of effective antileprotic drugs now it is entirely curable, but the deformities/defects already incurred may not be reversed. Use of antileprotic drugs can be dated back to centuries. Chaulmoogra oil ,with weak antileprotic property was used in Indian medicine for centuries.
- 3. Sulfones- Dapsone Phenazine derivatives-Clofazimine Antitubercular drugs- Rifampicin, Ethionamide Other antibiotics- Ofloxacin,Moxifloxacin, Minocycline, Clarithromycin
- 4. Sulfones- Phenazine derivatives-Clofazimine Antitubercular drugs- Rifampicin, Ethionamide Other antibiotics- Ofloxacin,Moxifloxacin, Minocycline ,Clarithromycin
- 5. Sulfones- Dapsone Phenazine derivatives- Antitubercular drugs- Rifampicin, Ethionamide Other antibiotics- Ofloxacin,Moxifloxacin, Minocycline ,Clarithromycin
- 6. Sulfones- Dapsone Phenazine derivatives-Clofazimine Antitubercular drugs- ,Ethionamide Other antibiotics- Ofloxacin,Moxifloxacin, Minocycline ,Clarithromycin
- 7. Diammino diphenyl sulfone,the oldest,cheapest,most active member of its class. Chemically related to sulfonamides and has the same mechanism of action-inhibition of PABA incorporation into folic acid by folate synthesis. Specificity for M.leprae - due to the difference in affinity of its folate synthase. But Dapsone resistance among M.leprae, first noted in 1964,has necessitated the use of multi drug therapy- MDT. Dapsone resistant M.leprae have mutated folate synthase which has lower affinity for dapsone. however the peak serum concentration of dapsone after 100mg/day dose exceeds the MIC for M.leprae by nearly 500 times ; it continues to be active against low to moderately resistant bacilli. The risk of relapse due to dapsone resistant bacilli is reported to be 2-3%.
- 8. Mild haemolytic aneamia Gastric intolerance Methaemoglobinaemia Paresthesias Cutaneous reactions Sulfone syndrome – a reaction which develops 4- 6weeks after starting dapsone treatment ; consists of fever , malaise , lymph node enlargement , desquammation of skin , jaundice & anaemia
- 9. Mild haemolytic aneamia Gastric intolerance Methaemoglobinaemia Paresthesias Cutaneous reactions Sulfone syndrome – a reaction which develops 4- 6weeks after starting dapsone treatment ; consists of fever , malaise , lymph node enlargement , desquammation of skin , jaundice & anaemia
- 10. Mild haemolytic aneamia Gastric intolerance Methaemoglobinaemia Paresthesias Cutaneous reactions Sulfone syndrome – a reaction which develops 4- 6weeks after starting dapsone treatment ; consists of fever , malaise , lymph node enlargement , desquammation of skin , jaundice & anaemia
- 11. Shouldnot be prescribed to patients with - severe anaemia (Hb <7g/dL) - G6PD deficiency - hypersensitivity reactions
- 12. A dye with leprostatic and anti-inflammatory properties The putative mechanisms of leprostatic action of Clofazimine are :- a. interference with the template function of DNA in M.leprae. b. alteration of membrane structure and its transport function. c. disruption of mitochondrial electron transport chain. When used alone, the clinical response to Clofazimine is slower than that to Dapsone and resistance develops in 1-3 years. Dapsone –resistant M.leprae respond to Clofazimine, but apparently after a lag period of about 2 months.
- 13. Reddish black discolouration of exposed parts Discolouration of hair and body secretions Dryness of skin and itching Acneform eruptions Phototoxicity Conjunctival pigmentation Nausea, Anorexia Abdominal pain Weight loss Enteritis with intermittent loose stools
- 14. To be avoided during early pregnancy. In patients with renal or hepatic damage.
- 15. This important tuberculocidal drug is also the most potent cidal drug for M.leprae : rapidly renders leprosy patients noncontagious. Up to 99.9% M.leprae are killed in 3-7 days by 600mg/day dose. Clinical effects of Rifampicin are rapid. However the nerve damage already incurred is little benefited. It is not satisfactory ,if used alone- persisters are found even after prolonged treatment and resistance develops.
- 16. Hepatitis Cutaneous syndrome-flushing, pruritus,rash Flu syndrome- with chills,fever, headache,malaise and watering of eyes Abdominal syndrome- nausea ,vomting,abdominal crampswith/without diarrhoea.
- 17. Hepatitis Cutaneous syndrome-flushing, pruritus,rash Flu syndrome- with chills,fever, headache,malaise and watering of eyes Abdominal syndrome- nausea ,vomting,abdominal crampswith/without diarrhoea. Urine and secretions may become orange-red but this is harmless. However ,it should not be given to patients with hepatic or renal dysfunction , as well as during Erythema nodosum leprosum and Reversal reactions in leprosy patients , because it can release large quantities of mycobacterial antigens by inducing rapid bacillary killing.
- 18. To deal with dapsone resistant strains of M.leprae and to shorten the duration of treatment,multidrug therapy with Rifampicin,Clofazimine and Dapsone was introduced by the WHO in 1981. Following the initiative under WHO Action Programme for Elimination of Leprosy, India introduced MDT for Leprosy through NLEP-National Leprosy Eradication Programme in 1982 Conventionally,all forms of leprosy had been treated with dapsone alone-monotherapy.(100-200mg,daily-5 days a week.duration od treatment depening upon type: TT- 4to 5 years,LL-8 to 12 years or lifelong.
- 19. The MDT is the regimen of choice for all cases of leprosy. Initially under standard MDT,the PBL cases were treated with Dapsone +Rifampicin for 6 months, while MBL cases were treated with Dapsone+Rifampicin+ Clofazimine for a minimum of 2 years or till disease inactivity/skin smear negativity was achieved. Due to operational reasons ,NLEP in India experimented with ‘fixed duration therapy of 24 month’(FDT-24) for MBL cases found that the relapse rates were similar to that in standard protocol. Later,FDT-24 was recommended by WHO in 1994 for all MBL cases whether disease inactivity/skin smear negativity was achieved or not. The 6 months FDT continues for PBL cases.
- 20. MDT leprosy Reduced risk of develpmnt of resistance Shortens duration of treatment Quick relief & safe even during pregnancy Renders MBL cases noninfectious
- 22. Many alternative regimens incorporating newer antileprotic drugs have been investigated. However, these are used only in case of Rifampicin - resistance or when it is impossible/inadvisable to employ the standard MDT regimen Intermittent ROM-rifampicin 600mg+ ofloxacin 400mg+ minocycline 100mg are given once a month for PBL and 12-24 month for MBL cases. Single dose ROM-a single dose of rifampicin + ofloxacin+ minocycline was given for single lesion PBL. Four drug regimen of rifampicin 600mg+sparfloxacin 200mg+clarithromycin 500mg+minocycline 100mg daily for 12 weeks.
Editor's Notes
- #16: Clinical effects- nasal symptms in L.leprosy subside within 2-3 wks Skin lesions regresses by 2 mnths
- #17: HEPTATITIS IN PREEXISTING LIVER DISEAE N IS DOSE RELATED
- #18: HEPTATITIS IN PREEXISTING LIVER DISEAE N IS DOSE RELATED
- #23: SINGLE DOS ROM-DISCONTINUED 4 drug-yieldd equilvalent clinical improvement in mblcases to std 12 mnth FDT.