Whenever you see a hypopigmented patch, first test its sensations. If sensations are absent look for other signs of Leprosy and refer for skin biopsy.

Rounded, hypopigmented patches over neck, back and chest are usually due to Tenia versi color.

Irregular hypopigmented patches over the cheeks in children are due to vitamin deficiency.

Complete depigmentation is due to vitiligo.

Leprosy

Hypopigmented anesthetic patches, Thickened ulnar, lateral popliteal and greater auricular nerves, nodules on ear pinna or elsewhere finger deformities.

Ta. DAPSONE 100mg X OD x 6 days per week.

Cap. Rcin 600mg x 1 daily x 14 days (loading dose) Then Cap. Rcin 600mg once/ month.

Cap. HANSEPRAN 100mg x alt daysd or 50mg x daily.

Duration of treatment=

6 moths – 1 year for Paucibacillary group (Tuberculoid Leprosy)

2 years or more for Multibacillary group (Lepromatous leprosy, skin AFB +ve)

Other drugs under trial  Ethionamide, Prothionamide, Ofloxacin, Minocyclin, Roxithromycin etc.

If Lepra reation:

Stop DAPSONE till acute reaction subsides.

Tab. HANSEPRAN 100mg x 2 daily x 3 weeks, then back to 50mg OD.

Tab. Wysolene 5mg x 2tds x 3 days, then 1 tds x 10 days.

After 3 weeks, start T. Dapsoe 25mg OD and increase the dose gradually.

Taenia Versicolor

Tolnadern Ointment locally bd (Tolnafate) or

SURFAZ ointment x 4 weeks.

Tab. FLUCOS 150mg x 2 tabs stat x every week x 4 weeks.

For resistant cases,

Tab. Phytoral 200mg x 1OD x 4 weeks.

Boil all clothes, particularly under clothes, during and after treatment.

Other drugs:

Selsun shampoo, applied 1 hour before bath x daily x 4 weeks.

CANDID-TV lotion, applied x daily x 3-4 weeks.

Vitiligo

Charescterised by complete depigmentation, nor hypopigmentation.

Tab. Manaderm 10mg 2-3 tabs at 7-8 am, followed by exposure to sunlight or ultraviolet light after 2 hours. Exposure time is gradually increased, till the patches are erythematous. Or

Tab. MELANOCYL (Ammoidine 100mg)

Apply Paraminol (Sunscreen) over surrounding normal skin, to prevent hyperpigmentation.

Cap. Becosules 1 OD x 2-6 months.

Four covered areas, apply Psorlin lotion or MELANOCYL lotion – diluted as necessary in spirit or eau-decolone.

If local solution is applied, Exposure to sun should be limited to 10-15 seconds only. For the rest of the day, the part should be covered.

If belbs and sunburns, develop,

BETNOVATE ointment locally tds.

Cover the area with calamine lotion.

Keep the area protected from light till the reaction subsides.

When lesions are few and in areas covered by clothes, try local treatment under guidance from a skin specialist.

Hypopopigmented patches on Cheek

(Pityriasis alba or Vitamin deficiency)

Betnocate ointment locally tds (Steroid ointment)

AD caps 1 bs x 60.

Syp. Betonin 2 tsp bd x 60 (Vit Bplex)

Tab. MEBEX 1 bd x 3

Instructions:

Use oiated soaps like Dove.

Apply moisturizer cream or coconut oil to skin after birth.

Drink 6-8 glasses of water everyday to keep skin well hydrated.

Patches resolve on their own, but after several months.

Cap. Rcin

Tab. HANSEPRAN

Tolnadern Ointment

Tab. Phytoral

Selsun shampoo

CANDID-TV lotion

Tab. Manaderm

AD caps

Syp. Betonin