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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e3181e659ce
Editorial Comment

Clinical Management of Leprosy Reactions

Agrawal, Amit MCh

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From the Department of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India.

Reprints: Amit Agrawal, MCh, Department of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, 442004, Maharashtra, India. E-mail: dramitagrawal@gmail.com; dramit_in@yahoo.com.

The author reports no conflict of interest.

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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REFERENCES

1. Agrawal A, Pandit L, Dalal M, et al. Neurological manifestations of Hansen's disease and their management. Clin Neurol Neurosurg. 2005;107:445-454.

2. Gill AL, Bell DR, Gill GV, et al. Leprosy in Britain: 50 years experience in Liverpool. QJM. 2005;98:505-511.

3. World Health Organization Regional Office for South-East Asia New D. Global strategy for further reducing the leprosy burden and sustaining leprosy control activities 2006-2010. Operational guidelines. Lepr Rev. 2006;77:1-50, IX, X.

4. Graham A, Furlong S, Margoles LM, et al. Clinical management of leprosy reactions. Infect Dis Clin Pract. 2010;18:234-237.

5. Girdhar BK, Girdhar A, Chakma JK. Advances in the treatment of reactions in leprosy. Indian J Lepr. 2007;79:121-134.

6. Shen J, Liu M, Zhou M, et al. Occurrence and management of leprosy reaction in China in 2005. Lepr Rev. 2009;80:164-169.

7. Franco-Paredes C, Jacob JT, Stryjewska B, et al. Two patients with leprosy and the sudden appearance of inflammation in the skin and new sensory loss. PLoS Negl Trop Dis. 2009;3:e425.

8. Goulart IM, Goulart LR. Leprosy: diagnostic and control challenges for a worldwide disease. Arch Dermatol Res. 2008;300:269-290.

9. Stefani MM, Guerra JG, Sousa AL, et al. Potential plasma markers of type 1 and type 2 leprosy reactions: a preliminary report. BMC Infect Dis. 2009;9:75.

10. Chambers JA, Baffi CW, Nash KT. The diagnostic challenge of Hansen's disease. Mil Med. 2009;174:652-656.

11. Lockwood DN, Reid AJ. The diagnosis of leprosy is delayed in the United Kingdom. QJM. 2001;94:207-212.

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