Leprosy Mailing List – March 8th, 2007
Ref.: Corticosteroids in
leprosy reactions.
From:
Ahmad L., Karachi, Pakistan
Dear Salvatore,
de Soldenhoff's comments (LML
Feb. 19th, 2007) on Grace Warren's paper (LML Jan. 11th,
2007) are very interesting indeed.
Grace Warren's paper contains advises on the managements of
reactions in leprosy and covers almost everything, but only medical
graduates and doctors working in leprosy can understand it, HOWEVER,
situation on the ground is a bit different. Leprosy technicians can only
follow guidelines given to them, alteration of such guidelines from
time to time will only create confusion especially when they are asked
to rule out concomitant diseases (for which they are not trained). Tuberculosis is the only
disease which they can rule out by doing sputum smears for AFBs for
which they do have facilities YET, secretions from nasopharynx of an
active lepromatous patients does contain AFBs. I have seen many of such
patients who were wrongly put on anti-tuberculosis treatment. Here in Pakistan, apart from
tuberculosis, malnutrition / anaemia, Malaria (which remains endemic
throughout the year and epidemics twice a year), Hepatitis B and
C, seasonal epidemics of other viral and bacterial infections are
common.
As far as dose of
corticosteroids for a certain length of time is concerned, we all know
that type one and type two reactions are different from each
other in their clinical presentation and histopathology HENSE require
different regimens of corticosteroids for different length of
time. The intensity of reaction in each type differ from one
individual to another BUT, the rule of the thumb is
that corticosteroids should be given sufficiently for sufficient time.
In my experience as leprosy
worker I would try to avoid corticosteroids in type 2 (ENL) reaction
as far as possible unless patient has acute neuritis, acute anterior
uveitis, orchitis or any other sign of acute nerve damage. Painful dermal nodules and
periosteal tenderness can be dealt with NSAIDs in combination
with other drugs mentioned in Dr Warren's article.
Leprosy technicians who start
corticosteroids should consult doctor regularly for dose and duration
of treatment.
With best wishes,
Dr Latif Ahmad
