Leprosy Mailing List – May 1, 2015
Ref.: (LML) Parenteral treatment of leprosy reactions
From: Herman Harun, Jakarta, Indonesia
Dear Pieter,
Our colleague Dr. Indropo Agnusi from Surabaya asked me for which (leprosy) reaction a high dose of prednisolone should be given.
First of all, I must say that I am a chest physician and specialist in TB control. A ‘large’ majority of my Asthma and COPD patients are prescribed corticosteroids. If symptoms are moderately severe, or deemed annoying, I would give 125 mg prednisolone intravenously. Shortness of breath, cough and sputum production would decrease dramatically. As for TB in pleurisy, I would prescribe 16 mg prednisolone daily for at least 2 months, when the pleural fluid will be absorbed (almost) completely.
In my experience as lung specialist (36 years including 3 years in the Netherlands), I have, fortunately enough, not met steroid dependency or cases of adrenal suppression.
I am not a leprosy doctor. But I became interested in the dramatic and tragic leprosy reactions, because my daughter’s involvement with leprosy work. So I wonder if larger doses of prednisolone (given parenteral 125 mg) would be helpful to - in some way - relieve the pain and suffering from leprosy reactions. The official regimen for leprosy reactions obviously, should be applied as usual.
Answering Dr Agnusi question, I can only offer the advice of the well-known specialist in the management of leprosy reactions, Dr Ben Naafs.
Dr Naafs gives for severe cases of ENL high doses of 100 – 180 mg prednisone (for the initial treatment of such cases methylprednisolone i.v. for 3 days would be a good alternative) and then reduced the dose until 0 mg within a month. In case when the ENL relapses, he would double the dose of prednisone (the dose at the moment of relapse) and reduce to zero in one month. He does not believe that a small maintenance dose prednisone would be helpful to prevent a relapse of the ENL
Best regards,
Muherman Harun
The Bellezza Permata Hijau
Albergo Tower
31st floor. Apt. 09-10
Jl. Letjen Soepeno
South Jakarta 12210
Tel: (021) 30485500
Mobile: 08990635289 / 0818153808
email: muhermanharun@gmail.com
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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