20 weeks of Prednisolone are better than 12 weeks in the treatment of type 1 (reversal) reaction

Leprosy Mailing List, September 8th, 2008

Ref.: 20 weeks of Prednisolone are better than 12 weeks in the treatment of type 1 (reversal) reaction
From: Kawuma H. J., Kampala, Uganda

Dear Salvatore,
I refer to the request by Dr. Ranawaka on the treatment of Type 1 (reversal) reaction (Leprosy Mailing List, August 25th, 2008). I wish to share the experience from Uganda.
Polar types of leprosy, both tuberculoid (TT) and lepromatous (LLp), are rare in our region. We have more cases of sub-polar lepromatous leprosy (LLs), lacking classical features of LLp.
The LLs cases were known to develop protracted and recurrent Type 1 reactions but which when well managed gave a very good result in the end for the patient.
We learnt to use more prolonged treatment with Prednisolone and this has been confirmed by good clinical trials. 20 weeks Prednisolone courses are better than 12 weeks courses. Of course we need to keep in mind other factors (already discussed in this forum) that can precipitate recurrent reactions or poor response to treatment.
H Joseph Kawuma
GLRA, Kampala, Uganda