Complications of Leprosy and Their Management

Immune Reactions in Leprosy (Type 1 and Type 2 Reactions)

Leprosy, caused by Mycobacterium leprae, can lead to various immune-mediated complications. These reactions, known as Type 1 (reversal reaction) and Type 2 (erythema nodosum leprosum), require specific pharmacological interventions.

Type 1 Reaction (Reversal Reaction)

Type 1 reactions occur due to changes in cell-mediated immunity, leading to inflammation of the skin and peripheral nerves.

• Symptoms: Painful, swollen skin lesions, nerve pain, loss of sensation.
• Treatment: Corticosteroids such as prednisone help manage inflammation. Thalidomide is occasionally used for severe cases.

Type 2 Reaction (Erythema Nodosum Leprosum - ENL)

Type 2 reactions involve immune complex deposition, leading to systemic inflammation.

• Symptoms: Painful nodular skin lesions, fever, malaise, arthritis.
• Treatment: Corticosteroids and thalidomide are the mainstay. Supportive care includes analgesics and antihistamines.

Management Strategies

Both reactions require tailored treatment depending on severity:

• Early diagnosis: Clinical assessment and nerve function evaluation.
• Pharmacological therapy: Steroids, thalidomide, NSAIDs.
• Long-term monitoring: Preventing nerve damage and disability.

Leprosy complications necessitate a multidisciplinary approach involving dermatologists, neurologists, and infectious disease specialists.