{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:07:50Z","timestamp":1789661270915,"version":"4.0.1"},"reference-count":6,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Leprosy Research Initiative","id":[{"id":"https:\/\/ror.org\/030m3dc08","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100017714","name":"Turing Foundation","doi-asserted-by":"publisher","award":["FP20.4\/708.20.04"],"award-info":[{"award-number":["FP20.4\/708.20.04"]}],"id":[{"id":"10.13039\/100017714","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wellcome Africa Asia Programme Vietnam core","award":["106680\/Z\/14\/Z"],"award-info":[{"award-number":["106680\/Z\/14\/Z"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Since 1982, the World Health Organization has recommended multidrug therapy (MDT) for the treatment of leprosy. This consists of three antibiotic drugs, namely rifampicin, dapsone and clofazimine. While MDT is effective, its adverse effects are under-recognized. Clofazimine causes near-universal skin discoloration, which 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 owing 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.<\/jats:p>","DOI":"10.1093\/ced\/llag349","type":"journal-article","created":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T11:33:19Z","timestamp":1785670399000},"source":"Crossref","is-referenced-by-count":0,"title":["Fear of clofazimine-induced skin discoloration as a barrier to leprosy treatment: urgent need for alternative therapeutic options"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3449-7184","authenticated-orcid":false,"given":"Nindya N","family":"Utami","sequence":"first","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia , Jakarta ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri V","family":"Muchtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana","family":"Krismawati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita L","family":"Patinggi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutia","family":"Rahardjani","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia , Jakarta ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliza\u00a0N","family":"Mulyadi","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia , Jakarta ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dian E","family":"Hasvitasari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer I","family":"Van Nuil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2034-8376","authenticated-orcid":false,"given":"Stephen L","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardyanto","family":"Soebono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7335-7313","authenticated-orcid":false,"given":"Marlous L","family":"Grijsen","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia , Jakarta ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026091711320240700_llag349-B1","doi-asserted-by":"crossref","first-page":"e2024062","DOI":"10.47276\/lr.95.4.2024062","article-title":"Adverse effects of clofazimine in the management of leprosy. A systematic review","volume":"95","author":"Lam","year":"2024","journal-title":"Lepr Rev"},{"key":"2026091711320240700_llag349-B2","doi-asserted-by":"crossref","first-page":"289","DOI":"10.12688\/wellcomeopenres.19455.1","article-title":"Metformin as adjunctive therapy in combination with multidrug treatment for multibacillary leprosy: a protocol for a randomized double-blind, controlled phase 2 trial in Indonesia (MetLep Trial)","volume":"8","author":"Krismawati","year":"2023","journal-title":"Wellcome Open Res"},{"key":"2026091711320240700_llag349-B3","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/her\/cyl158","article-title":"Iatrogenic stigma in outpatient treatment for Hansen\u2019s disease (leprosy) in Brazil","volume":"23","author":"White","year":"2008","journal-title":"Health Educ Res"},{"key":"2026091711320240700_llag349-B4","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/tmi.13977","article-title":"Clofazimine-induced cutaneous hyperpigmentation as a source of stigma in the treatment of leprosy: a cross-sectional study","volume":"29","author":"Nogueira","year":"2024","journal-title":"Trop Med Int Health"},{"key":"2026091711320240700_llag349-B5","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1001\/jamadermatol.2023.2787","article-title":"Mental health and psychosocial quality-of-life burden among patients with vitiligo: findings from the global VALIANT study","volume":"159","author":"Bibeau","year":"2023","journal-title":"JAMA Dermatol"},{"key":"2026091711320240700_llag349-B6","doi-asserted-by":"crossref","first-page":"311","DOI":"10.47276\/lr.93.4.311","article-title":"What factors influence adherence and non-adherence to multi-drug therapy for the treatment of leprosy within the World Health Organisation South East Asia region? 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