Fear of clofazimine-induced skin discoloration as a barrier to leprosy treatment: urgent need for alternative therapeutic options

Since 1982, the WHO recommends multi-drug therapy (MDT) fconsisting of three antibiotic drugs, namely rifampicin, dapsone and clofazimine. While MDT is effective, its adverse effects are underrecognized. Clofazimine causes near-universal skin discoloration, and is a key barrier to treatment acceptance and adherence because it visibly discloses leprosy. Using two compelling case studies in which MDT was declined or discontinued due to fears that clofazimine-induced dyspigmentation would reveal leprosy status and harm family reputation, we highlight the challenges posed by clofazimine and the limited availability of alternative treatment options in resource-constrained settings.