Leprosy Mailing List – October 28, 2017
Ref.: (LML) Steroid Dependency
From: José Augusto, Rio de Janeiro, Brazil
The comments from Dr Barbara (LML, October 18, 2017) are very interesting . I want to put some reflection about the need of use of corticosteroids (which is a very important and necessary drug in Leprosy): immuno-suppresive dose in the initial stage, independent of severity in the reactional states type 1 or type 2, and making the discontinuation of corticosteroids with precision about time and dose (anti-inflammatory dose).
When we reach a dose, for example, 30 mg/ day, 20 mg/day or 10 mg/day, these should be discontinued very slowly, so it would be 2-3 months for each one of these previous dose. Mainly when these reactional states are in multibacillary patients, which behaviour is different from Paucibacillary groups. Do not forget that one alternative in the severe reactional states or previously refractory states to the use of oral corticosteroids is the use of EV pulsotherapy (methylprednisolone).
I agree that methotrexate is an important drug as cyclosporine, and azathioprine or cloranbozil, but I am very worried about having the utilization of these drugs by professionals who don't have experience working with these drugs in this field. That is why we should always learn from the experience of a dermatologist or rheumatologist, who traditionally use these drugs in other diseases (Collagenosis, Psoriasis, etc), like in our Institute of Dermatology Professor Rubem David Azulay at Rio de Janeiro, Brazil and I suppose that so on in other services worldwide.
Dr. José Augusto da Costa Nery
Laboratório de Hanseníase/ ASA
Instituto Oswaldo Cruz - Fiocruz
Av. Brasil 4365, Manguinhos, Rio de Janeiro - RJ CEP 21040-360 - Tels.(21)2562-1588
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