## Classification and MDT Selection This patient has **paucibacillary (PB) leprosy**, specifically **tuberculoid leprosy (TT)**: - Few well-demarcated hypopigmented lesions (3–4 patches) - Negative slit-skin smear (BI = 0, no bacilli) - **Strongly positive lepromin test** (indicates good cell-mediated immunity, hallmark of TT) - Clear sensory loss within lesions - No nerve thickening ### WHO MDT Classification and Regimens | Classification | Number of Lesions | Slit-Skin Smear | Lepromin | MDT Regimen | Duration | |---|---|---|---|---|---| | **Paucibacillary (PB)** | ≤ 5 lesions | **Negative** | **Positive** | Rifampicin + Dapsone | **6 months** | | **Multibacillary (MB)** | > 5 lesions | **Positive** | Negative | Rifampicin + Dapsone + Clofazimine | **12 months** | **Key Point:** A negative slit-skin smear and positive lepromin test classify this patient as **paucibacillary (PB) leprosy**, which requires **two-drug MDT for 6 months**. ### Standard PB-MDT Regimen 1. **Rifampicin** 600 mg monthly (supervised) + daily unsupervised 2. **Dapsone** 100 mg daily (unsupervised) 3. **Duration:** 6 months with 6 supervised monthly doses 4. **No clofazimine required** in PB-MDT **High-Yield:** The **negative slit-skin smear is the key discriminator** between PB and MB leprosy. PB disease requires only 2 drugs for 6 months; MB requires 3 drugs for 12 months. This is heavily tested. **Clinical Pearl:** A positive lepromin test in a patient with few lesions and negative smear is diagnostic of tuberculoid leprosy, the least infectious form. These patients have excellent prognosis with standard PB-MDT. **Mnemonic:** **RD for PB, RDC for MB** — Remember: **Negative smear = PB (2 drugs, 6 months)**; **Positive smear = MB (3 drugs, 12 months)**. 
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