Written as an editorial commentary regarding Graham A, Furlong S, Margoles LM, Owusu K, Franco-Paredes C. Clinical Management of Leprosy Reactions on pages 235-238 of the journal.
Leprosy is a curable disease with well-defined etiology, and the appropriate treatment provided in early stages will avert the disabilities.1,2 Although the approach to the manifestations of leprosy depends on its clinical characteristics, nerve biopsy, and histological appearance of dermatological and neurological lesions, there is lack of better diagnostic tools and preventive and therapeutic strategies.1-3 In this issue of the journal, Graham et al4 very well discuss these issues, particularly in reference to the clinical management of leprosy reactions. Morbidity and, to a great extent, deformities in leprosy are the consequence of reactions occurring both in borderline patients (type 1, T1R, or reversal reactions) and in lepromatous patients (type 2, T2R, or ENL reactions),5 emphasizing the need for timely diagnoses and effective control of reactions and to prevent serious complications because of nerve damage.3,6 At present, there are no laboratory tests or markers available for the diagnosis or prognosis of leprosy reactions; however, over the last 3 decades, work has centered around findings on who are prone to get the reactions, identifying the risk factors, and improving the management of reactions to alleviate quickly the suffering and prevent and/or reverse nerve damage consequent to reactions, and several new drugs have been tried with promising results.1,5,7,8 In a recent study, the roles of circulating proinflammatory, anti inflammatory cytokines, and growth factors were compared among T1R and T2R patients and leprosy patients without reaction (matched for age, sex, and leprosy type), and the potential biomarkers of T1R identified were CXCL10 and interleukin 6 (IL-6), whereas IL-7, platelet-derived growth factor BB, and IL-6 may be laboratory markers of TR2.9 Additional studies on these biomarkers may help us to understand the immunopathologic mechanisms of leprosy reactions and indicate their usefulness for the diagnosis and for the clinical management of these events.9 Because of the relative rarity of this disease in developed countries, the present article becomes more pertinent as, because of its protean manifestations, diagnosis of leprosy may be delayed by 6 to 12 months, with a possibility of potentially irreversible sequelae.10 In summary, it becomes increasingly important to recognize these reactional states and their clinical manifestation at an early stage to avoid delay through inappropriate referrals to dermatologists or neurologists because early detection and intervention will help us to prevent the potentially severe disability.10,11
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