The leprosy problem--back to the dermatologists.

The incurable nature, coupled with the myths and mysticisms, kept leprosy away from the main stream of medicine. For similar reasons, public health experts also stayed away, leaving the problems mostly to the social workers and few leprosy specialists. It was the advent of an effective treatment with dapsone and later with MDT that leprosy came to be dealt within the public health terms, with emphasis on case detection and treatment. Hence the public health concept with its impact is a recent phenomenon in the long course of leprosy eradication. The principles on which the leprosy problem demanded a special attention was a) age old stigma about leprosy, b) need for clearance of the large number of backlog cases, c) special commitment of large number of NGOs, and d) availability of funds. To this may be added the urgency with which dapsone resistance was needed to be tackled. WHO showed a quick response to this threat of dapsone resistance, mobilized the available scientific developments and came out with a MDT strategy, in line with a pioneer MDT project conceived at Germany by Professor Freeckson of the Borstel Institute and executed in Malta about 10 years before the WHO recommendation. More than anything else, MDT brought leprosy to the main stream of medicine. Whether it is with long course, short course or single dose of MDT, more than 14 million cases have been treated between 1985 to beginning of 2005 with very few relapses.