From the Research
Leprosy reactions should be managed with prompt diagnosis and treatment to prevent permanent nerve damage, with Type 1 reactions typically treated with prednisolone and Type 2 reactions treated with thalidomide or alternative therapies such as prednisolone or clofazimine, as supported by the most recent and highest quality study 1.
Diagnosis of Leprosy Reactions
- Type 1 (reversal) reactions involve identifying new skin lesions with increased redness, swelling, and tenderness, along with new or worsening nerve function impairment.
- Type 2 reactions (erythema nodosum leprosum) present with painful red nodules, fever, joint pain, and sometimes neuritis, iritis, or orchitis.
Management of Leprosy Reactions
- For Type 1 reactions, prednisolone is the mainstay treatment, starting at 40-60mg daily for 2 weeks, then gradually tapering by 5-10mg every 2-4 weeks over 3-6 months based on clinical response.
- For Type 2 reactions, thalidomide 100-300mg daily is most effective but contraindicated in women of childbearing age due to teratogenicity; alternatives include prednisolone (40-60mg daily with similar tapering) or clofazimine (300mg daily for 1 month, then 200mg daily for 1 month, followed by 100mg daily) as shown in a comparative study 1.
- Severe neuritis requires immediate high-dose prednisolone (60-80mg daily).
Adjunctive Measures
- Regular monitoring of nerve function is essential, as is management of complications like ulcers and eye involvement.
- Pain control with NSAIDs or acetaminophen and physiotherapy to prevent disability are important adjunctive measures.
- The pathogenesis of lepra reactions involves shifts in the patient's immune response to Mycobacterium leprae antigens, with Type 1 representing increased cell-mediated immunity and Type 2 involving immune complex deposition, as discussed in recent research 2.
Treatment Considerations
- Patients should continue their multidrug therapy for leprosy without interruption.
- Awareness of atypical presentations of Type 2 lepra reactions is crucial for prompt diagnosis and treatment, as highlighted in a case series study 3.
- Thalidomide is the drug of choice for severe atypical lepra reactions due to its anti-tumor necrosis factor-α action, but its use is limited by teratogenicity, as noted in a study comparing thalidomide and prednisolone 4.