(LML) Steroid Dependency and the use of Methotrexate

 

Leprosy Mailing List – November 3,  2017

Ref.:    (LML)  Steroid Dependency and the use of Methotrexate

From:  Grace Warren, Sidney, Australia

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Note Editor: Two weeks ago, I mentioned that we have problems with sending messages through OUTLOOK. For the time being we use gmail.com till we have found another solution. Our excuses for this inconvenience, but if anyone has a suggestion?

 

Dear Pieter.,

Thank you for publishing that letter from Ben  Naafs LML, November 1, 2017). It certainly provides a good statement of the alternate methods of treating lepra reaction.  I thank him for including my use of Clofazamine alone and would like to   remind readers that the use of Prednisolone holds  risks  in many countries of the world where Pred can be bought without prescription. 

Once the patient or his parents see the " amazing" results of prednisolone they often go and buy it themselves and I personally have seen many patients with severe complications resulting from long continued use of prednisolone, requiring a careful withdrawal    from the pred and often this requires hospitalization, and careful instruction as to the dangers then involved.   As I have previously mentioned one patient was brought back to the  hospital in extremis some 6 months after his discharge after having been withdrawn from the pred and then having reconstructive surgery to his hand .  It must have been almost 12 months after he completed the pred and the doctor he saw on that occasion,  did not know about the previous pred affair.  The patient  had picked up a severe infection of flue and without suitable medical assistance  had rapidly deteriorated  and  he  collapsed in our OPD and could not be saved. 

Lepra reaction can be a real problem but there are lots of ways to manage it and thank you Ben for reminding every one of some alternatives that many students never hear of.

Kind regards, and thanks Ben,

Grace  Warren

Previously  travelling advisor for the Leprosy Mission In Asia

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com