## Classification and MDT Selection for Paucibacillary Leprosy **Key Point:** This patient has **tuberculoid leprosy (TT)**, a paucibacillary (PB) form, confirmed by: - Single well-demarcated lesion with clear borders - Complete sensory loss (hallmark of TT) - Low bacillary load (1+ AFB) - Strongly positive lepromin test (intact cell-mediated immunity) ### Differential Classification of Leprosy | Feature | Tuberculoid (TT) | Lepromatous (LL) | |---------|------------------|------------------| | **Number of lesions** | 1–5 (few) | Many (>5) | | **Border definition** | Sharp, clear | Ill-defined | | **Sensory loss** | Complete | Incomplete/absent early | | **Bacillary load** | 1–5 AFB | 3–6+ AFB | | **Lepromin test** | Positive | Negative | | **Classification** | Paucibacillary (PB) | Multibacillary (MB) | | **MDT duration** | **6 months** | **12 months** | ### MDT Regimen for Paucibacillary Leprosy | Component | Dosing | |-----------|--------| | **Rifampicin** | 600 mg monthly (supervised) | | **Dapsone** | 100 mg daily (self-administered) | | **Duration** | 6 monthly doses | | **Third drug** | NOT included in PB regimen | **High-Yield:** Paucibacillary leprosy requires **2-drug MDT (RD)** for **6 months only**. Clofazimine is NOT part of the standard PB regimen. **Clinical Pearl:** The strongly positive lepromin test indicates robust cell-mediated immunity, which is protective and allows for shorter treatment duration. Patients with TT have excellent prognosis with minimal risk of complications like erythema nodosum leprosum (ENL). **Mnemonic:** **RD-PB-6** = Rifampicin, Dapsone for Paucibacillary leprosy, 6 months. 
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