File Presentation Type I Leprosy Reaction Khunadi Hubaya

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 treated leprosy
patients
reactions
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
Antigens from dead bacilli will react

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

reaction
most often
CINICAL FEATURES
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
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
60mg/day tapered
up to 12 weeks.
Cyclosporin 5-10 mg/BB kg/day used
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
of 0.1%
given topical therapy
tacrolimus ointment twice daily
healing of all skin lesions after 2 weeks and

prednisolone dose become
of 12 weeks of treatment
zero over a period
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
Zinc 200 mg a day orally

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

TYPE I LEPROSY REACTION

Antigens from dead bacilli will react

In fact, the type 1 reaction = reversal

New lesions may show

The biggest cause nerve function damage

INFLUECE OF ANXIETY ON THE

increasing the formation of T-helper

Hospital for Tropical Diseases in

Reported that a case of borderline lepromatous

kg/day for 4 weeks treatment

given topical therapy

tacrolimus ointment twice daily

healing of all skin lesions after 2 weeks and

zero over a period

Tacrolimus: immunomodulatory and

Tugurejo General Hospital Semarang

Zinc 200 mg a day orally

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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