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Leprosy reactionA30.8
Synonym(s)
Erythema nodosum leprosum; Leprosy in reaction
DefinitionThis section has been translated automatically.
Episodic, acute exacerbation of leprosy with fever, exacerbation of the skin changes and involvement of internal organs due to a hyperergic immunity situation.
ManifestationThis section has been translated automatically.
Spontaneously, after leprosy testing, often under therapy.
Clinical featuresThis section has been translated automatically.
According to pathomechanism, a distinction is made between 2 forms:
- Type I: Cell-mediated. Inflammatory transformation of existing leprosy lesions. Occurs in leprosy tuberculoides, dimorphic leprosy and leprosy lepromatosa.
- Type II: Immune complex vasculitis (circulating immune complexes) probably underlies this reaction. Usually this reaction is triggered or accelerated by leprosy-specific drugs. Clinical: Erythema nodosum leprosum or erythema exsudativum multiforme. Erythema nodosum leprosum occurs not only on the lower extremity but also on the trunk and face. In lepromatous leprosy, general symptoms such as severe headache, chills, arthralgias, neuritis, aggravation of ocular and organ manifestations are also present. In tuberculoid leprosy, skin manifestations, acute nerve involvement, nerve swelling and neuralgia may occur.
TherapyThis section has been translated automatically.
- For light forms, acetylsalicylic acid (ASS Tbl.) or paracetamol (Ben-u-ron Tbl.) are sufficient. In more severe cases glucocorticoids like prednisone 30-40 mg/day, reduction according to clinic.
- In steroid-resistant relapses thalidomide systemic. Cave! Not approved in Germany, off-label use! Start with 400 mg over 48 hours, maintenance dose 50 mg/day (Pôrto LAB et l. 2019).
- Alternatively clofazimine (Lampren) initial 300 mg/day.
- Parallel continuation of the anti-infective therapy. S.u. Leprosy.
LiteratureThis section has been translated automatically.
- Bleharski JR et al (2003) Use of genetic profiling in leprosy to discriminate clinical forms of the disease. Science 301: 1527-1530
- Fucha J et al (1992) Diagnostic and therapeutic problems in leprosy patients from a dermatological point of view. Act Dermatol 18: 231-235
- Hatta M (2003) Epidemiology of leprosy. Molecular, biological, and immunological approach. Adv Exp Med Biol 531: 269-278
- Pôrto LAB et l. (2019) Deep Venous Thrombosis in Patients with Erythema Nodosum Leprosum in the Use of Thalidomide and Systemic Corticosteroid in Reference Service in Belo Horizonte
,Minas Gerais.Case Rep Dermatol Med: 8181507. - Rodellas AC et al (1992) Immunology of Leprosy. Dermatologist 43: 184-189
- Ross RR et al (2003) Lepromatous leprosy and reversal reaction in a Micronesian immigrant. Int J Dermatol 42: 893-894
- Ustianowski AP et al (2003) Leprosy: current diagnostic and treatment approaches. Curr Opin Infect Dis 16: 421-427