Effects of clofazimine alone or combined with dapsone on neutrophil and lymphocyte functions in normal individuals and patients with lepromatous leprosy

The effects of clofazimine on neutrophil activities such as random motility, migration to the leukoattractants endotoxin-activated serum and N-formyl-L-methionyl-L-leucyl-L-phenylalanine phagocytosis of Candida albicans, postphagocytic hexose-monophosphate shunt activity, and myeloperoxidase-mediated iodination and the effects of clofazimine on lymphocyte transformation to mitogens were assessed in vitro and after ingestion of the drug by normal individuals and patients with lepromatous leprosy. For in vitro studies, the concentration range of the drug investigated was 10(-6) M to 10(-2) M. for in vivo studies, subjects ingested 200 mg of clofazimine daily for a period of 5 days. At concentrations of 5 X 10(-6) M to 5 X 10(-3) M clofazimine caused a progressive dose-dependent inhibition of neutrophil motility without detectable effects on phagocytosis, postphagocytic hexose-monophosphate shunt activity, or myeloperoxidase-mediated iodination. Over the same concentration range, clofazimine inhibited lymphocyte transformation. The inhibitory effect on neutrophil motility was associated with a spontaneous stimulation of oxidative metabolism and could be prevented by coincubation of dapsone with clofazimine. after ingestion of clofazimine responsiveness of lymphocytes to mitogens was decreased in normal volunteers and leprosy patients: neutrophil motility in normal individuals was likewise inhibited.

Clofazimine-induced ichthyosis and its treatment

Clofazimine is a valuable drug which is used worldwide in the treatment of leprosy. Unfortunately, patients often resist its use because ichthyosis is a frequent side effect. The use of 25 percent urea in an emollient lotion appears to relieve the ichthyosis and, consequently, encourages the continued use of this drug.

Drug- and heavy metal--induced hyperpigmentation

Several categories of chemical and pharmacologic agents can cause alterations in cutaneous pigmentation, although the mechanisms differ and in several instances may be unknown. Fixed drug eruptions appear to have alteration of the basement membrane zone with incontinence of epidermal pigment as the mechanism of hyperpigmentation. Heavy metals produce increased pigmentation in part from deposition of metal particles and in part from an increase in epidermal melanin production. The antimalarials may bind to melanin. The phenothiazines and minocycline produce pigmentation from deposition of the drug. The mechanism, site, and nature of the pigment occurring with antineoplastic agents is not well understood, but the location is most likely predominantly epidermal. Clofazimine (Lamprene) alteration in pigmentation appears to result from deposition of the drug in subcutaneous fat.

Gastro-intestinal side effects of clofazimine

Three out of 30 patients of leprosy getting clofazimine therapy developed severe gastrointestinal side effects following the therapy in the dose of 100 mg after one month, eight months and five weeks respectively. One of the patients died due to the side effects. Indian patients appear to be more prone to severe gastrointestinal side effects of clofazimine and may develop the same after shorter duration of therapy with smaller doses of the drug.

Intra-neural ceroid-like pigment following the treatment of lepromatous leprosy with clofazimine (B663; Lamprene)

A 33 year old male Nigerian presented with widespread involvement of peripheral nerves, several of which were tender and painful. Nerve biopsies confirmed the presence of Mycobacterium leprae in both endoneurial and perineurial areas, mainly in foamy macrophages (Virchow cells), but there were also large accumulations of an amorphous, acid-fast and alcohol-fast material which was not obviously of bacterial origin. Appropriate stains indicated that this had many characteristics of lipofuscin. Although not previously known, it was at this stage discovered that the patient had received treatment with anti-leprosy drugs nearly three years before presentation in this country. One of these was clofazimine, an aniline aposafranine derivative known to produce a ceroid-like pigment in the tissues of patients treated with this drug or lepromatous leprosy.

Splenic infarction and tissue accumulation of crystals associated with the use of clofazimine (Lamprene; B663) in the treatment of pyoderma gangrenosum

A male patient 68 years, suffering from pyoderma gangrenosum which was resistant to conventional treatment, received clofazimine 400 mg daily for 5 months, then reducing to 300 mg daily for the next 6 months. Eleven months after starting the drug, he was admitted to hospital with severe abdominal pain, laparotomy revealing infarction of the spleen, with violaceous congestion of the small bowel. The spleen was removed and post-operative recovery was satisfactory. Histopathological examination of the spleen (removed at operation) and of tissue from a duodenal biopsy (taken postoperatively) showed large numbers of striations and outlines suggestive of crystal deposition. Mesenteric lymph node revealed a massive accumulation of crystals in cortical and medullary sinuses. The findings emphasize that clofazamine should not be used in high dosage over prolonged periods of time, except under close clinical and laboratory supervision, and for conditions not amenable to other drugs.

Clofazimine in the treatment of pyoderma gangrenosum

Ten patients with pyoderma gangrenosum, seven female and three male, 25 to 94 years old, mainly with multiple lesions, have been treated with clofazimine, 100 mg three times daily. Associated disease was registered in three patients: diabetes mellitus, a previous adenocarcinoma of the colon treated by hemicolectomy, and pustulosis palmoplantaris. In a further patient, M-component was found in the serum. In seven cases the lesions were completely healed by two to five months of therapy, and in three cases the ulcers healed partially. Side effects were redness of the skin in seven cases and dryness of the skin in two patients. No hematological side effects occurred. The working mechanism is still obscure.

Treatment of pustular psoriasis with clofazimine

Two cases of generalized pustular psoriasis (von Zumbusch) were successfully treated with clofazimine. No side effects were noted except deep red staining of the skin which faded afterwards.

Clofazimine in the treatment of dapsone resistant leprosy

Dapsone resistant patients treated with clofazimine 100 mg daily show a consistent response to treatment. Concern is expressed regarding the prolonged persistence of viable organisms during treatment, with the attendant risk of further resistance developing. The importance of prevention of this problem is discussed.

Clinical trial with clofazimine in leprosy

This paper summarises our clinical experience with clofazimine in the treatment of 25 cases of reactive states of lepromatous and borderline leprosy and 7 lepromatous patients not responding to dapsone. Corticosteroids, which had to be given for the control of reactions, could be withdrawn and daspone therapy reintroduced during the period of administration of clofazimine. A schedule for the management of moderately severe reactions is recommended. The results of clofazimine treatment were also equally impressive in the group of patients, possibly harbouring dapsone resistant bacilli (in view of their lack of improvement in spite of administration of dapsone under controlled conditions). Clinical regression was associated with a fall in the mean levels of morphological index from 6.8 to 0.5. The need to realise the real indications of this highly useful drug in the treatment of leprosy is stressed.