Management of type 1 (reversal) reaction

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-DermatologoDirector Unidad de Lepra del Distrito Nacional
Coordinador Comite de etica interno (Internal review board)
Instituto Dermatologico y Cirugia de PielDr Huberto Bogaert Diaz (IDCP-Dr.HBD)
office (809) 684-3257 ext 234
Fax (809) 681-7687
Apartado postal 1090Corazones Unidos
Dermatologia y Cosmiatria(809) 683-6185mobile (809)815-1060
e mail: jpericheathvtudr.org
Santo Domingo DN, Rep Dominicana