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Reactions in Leprosy

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Leprosy

Abstract

It can be stated that there is no leprosy without nerve damage. Most of this damage takes place during exacerbations of the disease called reactions. There are two main types of reactions: type 1 leprosy reaction (T1R) and type 2 leprosy reaction (T2R). T1R complicates the course of borderline leprosy, namely borderline tuberculoid (BT), mid-borderline (BB), and borderline lepromatous (BL) leprosy. It is related to increase of the patient’s cell-mediated immunity against M. leprae antigenic determinants. Clinically it is characterized by signs and symptoms of neuritis and increased inflammation of existing skin lesions. Its treatment is based on immunosuppression by means of prednisolone. T2R occurs in BL, subpolar lepromatous (LLs), and polar lepromatous (LLp) leprosy. It is related to imbalance of cellular immunity and humoral immunity, leading to the formation of immune complexes. T2R is a generalized disease, with many organs and tissues involved. Its most common manifestation is episodic, self-limiting, recurrent eruption of tender, erythematous nodules. The treatment is based on use of thalidomide, prednisolone, and clofazimine. Severe reactions are the only common medical emergencies in leprosy; they need to be diagnosed and treated in a timely fashion to prevent peripheral nerve damage and permanent disability.

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Acknowledgment

This chapter is based on B. Naafs (2000) Current views on reactions in leprosy. Indian J Lepr 72: 97–122 [20]. (With kind permission by the Indian Journal of Leprosy.)

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Authors and Affiliations

  1. Stichting Polderma Emmeloord/Steenwijk/Urk, Munnekeburen, Friesland, The Netherlands

    Bernard Naafs

  2. Regional Dermatology Training Centre (RDTC), at KCMC, Moshi, Tanzania

    Bernard Naafs

  3. Instituto Lauro de Souza Lima (ILSL), Bauru, SP, Brazil

    Bernard Naafs

  4. Centre for Research Centre in Leprosy and Tropical Dermatology (CIRLEP), University of Genoa, Viale Benedetto XV n. 7, 16132, Genoa, Italy

    Salvatore Noto

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  1. Bernard Naafs
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  2. Salvatore Noto
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Correspondence to Bernard Naafs .

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Editors and Affiliations

  1. Dipto. Scienze della Salute (DISSAL), Centro per la Ricerca sul Morbo di, Università di Genova, Via Balbi 5, Genova, 16126, Italy

    Enrico Nunzi

  2. Universitätsklinik für Dermatologie und, Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, Graz, 8036, Austria

    Cesare Massone

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Naafs, B., Noto, S. (2012). Reactions in Leprosy. In: Nunzi, E., Massone, C. (eds) Leprosy. Springer, Milano. https://doi.org/10.1007/978-88-470-2376-5_21

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  • DOI: https://doi.org/10.1007/978-88-470-2376-5_21

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  • Publisher Name: Springer, Milano

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  • Online ISBN: 978-88-470-2376-5

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