Leprosy
Mailing List, September 15th, 2008
Ref.:
Management
of type 1 (reversal) reaction
From:
Periche
Fernandez J.,
Santo Domingo
,
Dominican Republic
Dear
Salvatore,
This is
about the request of information about treatment of type 1 (reversal)
reaction from Dr Ranawaka R., from
Anuradhapura
,
Sri Lanka
dated Mon, August 25, 2008.
Dr Ranawaka
reported a 60 year old woman with lepromatous leprosy (LL) and
presenting with type 1 reaction.
She was treated with oral prednisolone for 3 months. At
the tapering off of prednisolone she developed recurrence of type 1
reaction twice. Dr
Ranawaka’s questions are:-
Question
1.
”Is type 1
reaction described in lepromatous leprosy?”
No! type one
reactions are seen in borderline (BT, BB, BL) cases, if the reaction
is really type 1 then the patient is not LL, but she probably is a BL
case. This means a
borderline case but close to the LL side on the leprosy spectrum. Alternatively the patient may
have sub polar lepromatous leprosy (LLs). On the other hand it might be
that the patient is having a type 2 reaction! A carefully look at biopsy
taken form the lesions and a new bacteriology, both compared to
previous biopsy and bacteriology might give the clue and tell the
difference. If there are
ENL like nodules this will give diagnosis of the type 2 reaction.
Question 2.
“Is there
a recurrent type of type 1 (reversal) reaction?”
Yes. Both
types of reactions are recurrent.
Question
3.
“Is the 3
month course of oral prednisolone the standard treatment?”
No. Some patients need longer than
that.
There may
also be a late reaction; that is to say a reaction after ending MDT. Biopsy and bacteriology are
necessary to rule out the presence of live acid fast bacilli (these
would indicate the need for prolongation of antibacterial therapy).
Regards,
Dr. Juan Periche Fernandez
Medico-Dermatologo
Director Unidad de Lepra del Distrito Nacional
Coordinador Comite de etica interno (Internal review board)
Instituto Dermatologico y Cirugia de Piel
Dr Huberto Bogaert Diaz (IDCP-Dr.HBD)
office (809) 684-3257 ext 234
Fax (809) 681-7687
Apartado postal 1090
Corazones Unidos
Dermatologia y Cosmiatria
(809) 683-6185
mobile (809)815-1060
e mail: jperiche@hvtudr.org
Santo
Domingo DN, Rep Dominicana
