Type I Leprosy Reaction Edit

TYPE I LEPROSY REACTION
KHUNADI HUBAYA
DERMATOVENEREOLOGY DEPARTMENT OF
TUGUREJO GENERAL HOSPITAL, SEMARANG,
CENTRAL JAVA, INDONESIA
PRESENTED IN THE INDONESIAN DUTCH TROPICAL DERMATOLOGY MEETING, YOGYAKARTA, APRIL 7TH - 9TH ,2011
INTRODUCTION
Leprosy
Reaction
State of symptoms and signs of acute

inflammation in the lesions of leprosy
patients
immunological disorder caused
by hypersensitive reaction of M.leprae
antigens.
Fifty percent (50%) of
patients
reactions
treated
leprosy
Reaction occurs :
Leprosy occurs
Occur due to of immunological
changes as a result of antileprosy

treatment
Occur spontaneously other infectious
diseases, anemia, mental and physical
stress, puberty, pregnancy, childbirth,
surgery.
Anti-leprosy treatment
trigger factors
most frequent
TYPE I LEPROSY REACTION

T
I LR = upgrading reaction, borderline reaction,

tuberculoid reaction, leprosy nonlepromatous
reaction
Occurs in 30% of patients with borderline leprosy (BT,
BB, BL)
Appears in: - First 6 months of treatment
- Occur 2 years after the first
treatment
- Not received therapy
Jopling : delayed hypersensitivity reaction (type IV
hypersensitivity reactions Coombs and Gell )
Antigens
from dead bacilli will react

with T lymphocytes
changes in celluler
immune system.
Result
: upgrading/reversal
to tuberculoid
form ( increase cellular immune system )
down grading
to lepromatous
form( decrease cellular immune system)
In
fact, the type 1 reaction = reversal

reaction
most often encountered, down
grading reaction is rarer
CINICAL FEATURE
Prominent
and shiny erythematous plaques,

few days later, the color can change to
purplish or brownish. The firm edge of the
lesion, pressurized pain or feels hot when
touched.
In
severe reactions
desquamation or
ulceration due to necrosis.
New
lesions may show subclinical lesions

Neuritis of the nerves are located
superficially.
Mild neuritis, painless enlarged nerves,
anesthesia , paralysis.
In severe cases
nerve enlargement,
spontaneous
or
pressurized
pain,
anesthesia on the dermatomes.
The
biggest cause nerve function damage

(30% patients)
claw hand, drop foot,
facial palsy with or without lagophtalmus ,
keratitis.
Mild systemic symptoms : facial and leg
edema. Severe symptoms: malaise, fever,
face hands and leg edema
Histopathological: epitheloidcell granuloma
edema, dermal edema, plasma cells and
granuloma fraction
INFLUECE OF ANXIETY ON THE

IMMUNE SYSTEM (WEBSTER, 1998)
Person experiences excessive anxiety
symptoms
CRH (Cortico Releasing
Hormone) release catecholamin hormone
more than the glucocorticoid.
Catecholamin hormone
stimulate
macrophages
stimulate IL 1O
increasing the formation of T-helper

cell (Th-2)
more humoral immunity will
be formed
Manifestation type 2
leprosy reaction.
Minute glucocorticoid
macrophage to
slightly stimulate IL - 12 to secrete Th-1
cells
the formed cellular immunity will
be small
Manifestation type 1 leprosy
reaction
MANAGEMENT
Rest
or immobilization
Elimination
of triggering factor
Continuing
treatment of anti-leprosy drugs
Analgesic
sedatives to cope with pain
Provision
of anti reaction drugs
Mild reaction
Nonmedicamentosa: rest,
immobilization
Medicamentosa: paracetamol,
mefenamic acid, aspirin, piroxicam,
diclofenac sodium,cyclooxygenase 2
(COX 2)
Severe reaction
Improvement of general condition by
improving fluid/electrolyte balance
Must be given corticosteroid
Provision of Corticosteroid
Prednisone
40-60 mg/day single morning

dose,
tapering
slowly
until
a
few
months/years.
Corticosteroid > one month, required
minimum
dose
and
alternate-day
treatment
Prednisone or prednisolone of 0.5 to 1.0
mg/BB kg/day single morning dose,
tapering
slowly
and
alternate-day
treatment is more tolerated.
Hospital
for Tropical Diseases in London:

prednisolone 30-40 mg tapering to zero
over a period of 5-6 months.
Prednisolone
30 mg/day, slowly tapered

to zero up to 20 weeks
is better than
60 mg/day tapered up to 12 weeks.
Cyclosporin
5-10 mg/BB kg/day used if

steroid fail,or as a steroid sparing agent.
Reported
that a case of borderline lepromatous

leprosy with type 1 leprosy reaction treated with
prednisolone 1 mg/BB kg/day for 4 weeks
treatment
condition did not improve and the
skin lesions remained painful
given topical
therapy of 0.1% tacrolimus ointment
twice daily
healing of all skin lesions after 2
weeks and prednisolone dose become zero over
a
period of 12 weeks of treatment
Tacrolimus:
immunomodulatory and
immuno suppressive agent
Surgery
During the treatment

failure in the
repair of some nerve function
exploratory surgery to relieve mechanical
compression
Tugurejo General Hospital Semarang

Uses corticosteroid treatment :
methylprednisolone dose
=
prednisone/prednisolone
dependence
and the side effect is smaller.
Astaxanthin 4 mg, twice a day orally,
astaxanthin a strong antioxidant potential
against strong free radicals and
having anti-inflammatory effects by
inhibiting cytokin and chemokin
Zinc
200 mg a day
stabilizing the cell
membrane, machrophage and mast cells that play
a role in the immune system.
Changes in zinc metabolism
function of
immune cells to become abnormal.
Zinc supplementation
improve of zinc
metabolism
increasing immune response
against M.Leprae.
Tgl 9 Oktober 2009 hari pertama
Tgl 15 Oktober 2009 (hari ke 6)
Tgl 22 oktober 2009( hari ke 13)
Tgl tgl 26 Oktober 2009 (hari ke17)
Tgl 24 November 2009 (hari ke 45)
Sandra Dewi, Duta Lepra Indonesia
leprosy
work is not merely medical relief;

it is transforming frustration of life into joy of dedication,
personal ambition into selfless service
Mahatma Gandhi
THANK YOU

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TYPE I LEPROSY REACTION

State of symptoms and signs of acute

changes as a result of antileprosy

TYPE I LEPROSY REACTION

I LR = upgrading reaction, borderline reaction,

from dead bacilli will react

fact, the type 1 reaction = reversal

and shiny erythematous plaques,

lesions may show subclinical lesions

biggest cause nerve function damage

INFLUECE OF ANXIETY ON THE

increasing the formation of T-helper

treatment of anti-leprosy drugs

sedatives to cope with pain

of anti reaction drugs

40-60 mg/day single morning

for Tropical Diseases in London:

30 mg/day, slowly tapered

5-10 mg/BB kg/day used if

that a case of borderline lepromatous

During the treatment

Tugurejo General Hospital Semarang

Tgl 9 Oktober 2009 hari pertama

Tgl 15 Oktober 2009 (hari ke 6)

Tgl 22 oktober 2009( hari ke 13)

Tgl tgl 26 Oktober 2009 (hari ke17)

Tgl 24 November 2009 (hari ke 45)

Sandra Dewi, Duta Lepra Indonesia

work is not merely medical relief;

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