Leprosy Mailing List – December 2, 2018
Ref.: (LML) Steroids missing in action
From: Ajit P, Mumbai, India
Respected Sir,
Over last three years from my observations from Mumbai of leprosy patients managed in leprosy programs at govt institutes, missing in action are steroids!!
Often the nerve function impairment is overlooked or not diagnosed in the first place, especially true in silent neuropathy. So, we have patients with fully completed MB MDT and deformities like the immobile claw hand and foot drop! So even a mild BT Hansen ends up with an immobile claw which if he is a manual labourer can be employment threatening!
It is imperative to reemphasize that only giving those twelve blister packs is not management of leprosy. Nerve function impairment must be diagnosed early on and looked for in each follow up visit actively. Health care workers must be taught importance of actively looking for Wartenburg sign (involuntary abduction of the fifth -little- finger), foot drop or lagophthalmos in each visit.
Moreover, after diagnosis the patient is relegated to a govt health centre near his residence and he is under care of paramedical workers or MBBS docs (non-dermatologists). The patient is only referred to dermatologist in case of severe complications and early nerve impairments are often overlooked.
Physiotherapy is also equally important.
Health care workers need to be explained the importance of timely recognition of nerve function impairment and importance of steroids and for relatively long term.
Also, one must remember that thalidomide works for cutaneous manifestations of type 2 lepra reactions. Often type 2 lepra reactions have associated neuritis. Here giving steroids is a must.
Thanx,
Dr Ajit
Consultant dermatologist
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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