The evidence base for newer drug combinations and shorter regimens is weak

Leprosy still poses major therapeutic challenges. We have effective antibiotics to cure the infection, but the immune mediated peripheral nerve damage can continue long after effective antimicrobial treatment has started, and patients continue to be stigmatised. Effective management should therefore include treatment of nerve damage and reactions, prevention of disability, and reduction of stigma. The regimens recommended by the World Health Organization of six or 24 months' multidrug treatment (rifampicin, dapsone, and clofazimine) produce good clinical responses and low rates of relapse. The long term outcome for shorter regimens and other drug combinations, however, is not known. Testing for recent nerve damage and treating it with steroids is essential. Dermatologists already have an important role in treating patients in the large Indian and Brazilian cities, and this is likely to increase as leprosy programmes are integrated into primary care.