Leprosy reaction A30.8

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.

• 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.

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