While for the last thirty years Dapsone (4, 4, diaminodiphenyl sulfone; DDS) has been the chemotherapeutic treatment of choice in the management of leprosy, other non-sulfone compounds have been used when patients have shown either sulfone resistance or sulfone sensitivity. Unfortunately, however, there have gradually appeared a significant number of dapsone resistant and non-sulfone resistant patients {i. e., patients resistant to the conventional chemotherapeutic management of leprosy), thus necessitating the synthesis of additional antileprotic medication. At present, it appears that Lamprene (Clofazimine) is the most adequate preparation for the treatment of sulfone and/or other anti-leprotic drug resistant cases, as well as reactive states. The work of Browne and Hogerzeil in 1962, and subsequent studies by other workers, have demonstrated lamprene´s anti-leprotic and anti-inflamatory effects. The drug has also been used successfully in the management of the reactive patient. However, as its most untoward side effect, the drug causes an unsightly darkening of the skin in those areas where the concentration of M. leprae is greatest.
Because the literature provides only sparse data on the effect of lamprene on the morphological (MI) and bacteriological (BI) indices of bacteriologically open patients, the authors undertook the following study:
Eighteen dapsone resistant patients, two of whom were in lepra reaction, received a daily dose of 100mg. of lamprene during a period ranging from 4 to 22 months. Patients were kept under close clinical observation and bacteriological samples were taken at an average of three month intervals from eight different sites on the body. All subjects were in residence at the National Leprosy Hospital of Korea on Sorok island. The study yielded the following results:
1) Within 3 to 8 months after the administration of lamprene, the MI decreased to the base line in all patients save one.
2) In the short term administered group (less than 10 months), 6 of 13 patients showed a BI increase in inverse proportion to an MI decrease during the initial stage of lamprene administration. However, the BI began to decrease between the 4th and 5th months of treatment. Of the remaining 7 patients, all showed a decrease in both BI and MI.
3) In the long term administered group (more than 10 months), the BI, an indicator in the evaluation of long term administration, gradually decreased in 4 of 5 patients. In the remaining patients the BI increased.
The authors regard the inverse relationship between the BI and MI as the result of the increment of bacilli secondary to the destruction of M. leprae by lamprene. That 2 groups showed a decrease in both BI and MI is interpreted as lamprene´s biochemical intervention so as to render M. leprae more susceptible to phagocytosis. While no ready explanation can account for the single case in which the BI increased and the MI also increased, the possibility that there might be a strain of M. leprae resistant to lamprene must be ruled out.
Thus, given the above results, the authors conclude that lamprene is a valuable anti-leprotic drug not only for DDS resistant patients but also for patients in lepra reaction. Moreover, this drug seems to find its best setting in the leprosarium where the untoward side effect of darkened skin does not in any way diminish the patient´s social relationships.
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