10 April 2012
Ref. Downgrading type 1 reaction?
From: H K Kar, New Delhi, India
Dear Dr Noto,
Thank you very much to Drs Barreto and Cabral for presenting their case (LML March 24th, 2012). A very good case of a child with untreated mid borderline (BB) leprosy presenting with downgrading (DG) type 1 reaction.
Many of us do not accept the existence of DG type of type 1 reaction. Many of the so called untreated borderline patients presenting with DG type 1 reaction are in true sense upgrading (UG) type 1 reaction. On taking detailed history we come to know that in the immediate past they took some antibiotics responsive to M. leprae for other infections which precipitated UG type 1 reaction. In true sense these reactions should be considered as Up-grading type 1 reaction, rather than DG type 1 reaction.
With Regards.
Dr (Prof.) H K Kar
Consultant & HOD
Department of Dermatology, STD & Leprosy
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
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