## Clinical Diagnosis: Tuberculoid Leprosy ### Key Diagnostic Features Present **High-Yield:** This patient has classic tuberculoid leprosy: - **Single well-demarcated lesion** (1–5 lesions is TT range) - **Complete sensory loss** (anesthesia is hallmark) - **Negative slit-skin smear** (TT is always smear-negative) - **Absent sweating** (anhidrosis in the lesion) - **Clear-cut border** (sharply demarcated) - **No systemic involvement** ### WHO Classification for Leprosy Treatment **Key Point:** WHO simplified leprosy into two operational categories for treatment purposes: | Category | Lesions | Slit-Skin Smear | MDT Regimen | Duration | |----------|---------|-----------------|-------------|----------| | **Paucibacillary (PB)** | ≤5 | Negative | Rifampicin + Dapsone | 6 months | | **Multibacillary (MB)** | >5 | Positive | Rifampicin + Dapsone + Clofazimine | 12 months | **Clinical Pearl:** Tuberculoid leprosy = Paucibacillary disease. The single lesion and negative smear confirm PB classification. ### Treatment Protocol for Paucibacillary Leprosy **Mnemonic: PB-MDT = "Rifampicin + Dapsone for 6 months"** 1. **Rifampicin** 600 mg once monthly (supervised) + daily unsupervised 2. **Dapsone** 100 mg daily (self-administered) 3. **Duration:** 6 months (12 supervised doses) **Warning:** Do NOT use clofazimine in paucibacillary disease—it is reserved for multibacillary cases to prevent resistance and reduce treatment duration. ### Why Biopsy Is Not Needed **High-Yield:** Clinical diagnosis of leprosy is sufficient for treatment initiation when: - Slit-skin smear is available (negative in TT) - Characteristic lesion morphology is present - Sensory loss is demonstrated - Lepromin test (if done) is positive in TT Histopathology is confirmatory but not required for starting treatment in endemic areas.
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