Clofazimine (Lamprene - Geigy), a fat-soluble, orange dye with both anti-mycobacterial and anti-inflammatory properties,1 is now being advocated as the main second-line drug in the treatment of leprosy. It has been recommended for patients with any type of leprosy who develop serious drug reactions (e.g. haemolytic anaemia or hepatitis) to dapsone, and for long-treated lepromatous patients in whom the organisms have become sulphone-resistant. These two complications are uncommon, but because of its anti-inflammatory properties clofazimine has also been recommended in the treatment of ‘lepra reactions’, which are inflammatory episodes that frequently complicate lepromatous leprosy.2 There are two main types: (a) erythema nodosum leprosum (ENL), an immune-complex disease3 which may develop in about half of all treated lepromatous patients; (b) lepra reactions associated with changes in cell-mediated immunity2 4 which may occur in both treated and untreated patients in many types of leprosy. Clofazimine may also be the best drug for tropical ulcers due to Mycobacterium ulcerans infection.5
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