Treatment of the Disease
Before the advent of sulfone treatment, therapy for Hansen's disease consisted of potassium iodide, arsenic, antimony, copper, sera, vaccines, aniline dyes, thymol, strychnine, baths, X-rays, radium, and electrical current. Chaulmoogra oil, a product of the seeds of several species of the Hydnocarpus tree, was a hallmark of therapy in the late 19th and early 20th centuries, with varying reports of documented success and indifferent results. The oil was mixed with lard and applied locally as well as taken orally several times/day. Commercial preparations of chaulmoogric acid became available in 1909 by Bayer and Company under the name Antileprol and later Chaulmestrol (Winthrop Chemical Company). Oral therapy appeared to be the most effective, but the dosage had to be titrated over time primarily because of nausea. The drug was also prepared as an injection, but the adverse effects of fever, local reactions, and abscess made therapy difficult to tolerate.
In his book Alone No Longer, Stanley Stein, a pharmacist who contracted Hansen's disease, filled capsules of "foul smelling oily liquid" that left him "so nauseated that [he] quickly recorked the bottle." Ironically, he distributed pills in the cafeteria at the leprosarium in Carville, Louisiana. He also described a chaulmoogra oil injection combined with olive oil and benzocaine that left "painful suppurating abscesses" and resulted in several hospitalizations.
Although modern recommendations for therapy differ between the U.S. Public Health Service NHDP and the WHO, antibacterials targeting M. leprae are the mainstay of therapy. Table 1 shows recommendations for therapy, noting WHO suggestions for directly observed therapy.[33,34,35] Pharmacokinetic properties of the antibacterials are listed in Table 2 .[36,37,38]
Pharmacotherapy. 2012;32(1):27-37. © 2012 Pharmacotherapy Publications