The document discusses the classification of leprosy reactions, highlighting type 1 reversal reactions characterized by immune status shifts and type 2 reactions, which involve tender cutaneous nodules and systemic symptoms in lepromatous patients after treatment. It details the histopathological changes associated with these reactions, including increased lymphocytes and granulomas in type 1, and neutrophil infiltration in type 2. The implications of these reactions on skin, nerve, and systemic involvement are also summarized.

2. .
• Sudden episodes of exacerbation occurring during the silent course of
leprosy

3. CLASSIFICATION
• Based on the shift of immune status
• Or in leprosy patients on treatment
• TYPE 1 : REVERSAL REACTION
• TYPE 2 : ERYTHEMA NODOSUM LEPROSUM

4. TYPE 1 : Reversal Reactions
• Borderline groups are unstable and move across the spectrum in either
direction
1. UPGRADING REACTION
– In BL patients on Rx
– Increased CML
– Upgrade towards tuberculous type
2. DOWNGRADING REACTION
– In BT patients who downgrade to lepromatous type
– Lowering of CML

5. .
• Type 4 hypersensitivity reaction
• Do not occur in immunologically stable polar groups
• Skin &nerve involvement
• Previous lesions become erythematous edematous and
sharply delineated and maybe tender
• Nerves involved – thickened , tender & deficit
• Constitutional symptoms absent
• Occurs early in the course of Rx

6. .

7. TYPE 2 : Erythema nodosum leprosum
• In lepromatous patients
• After Rx
• Tender cutaneous nodules
• Fever
• Iridocyclitis , Epididymo orchitis , periostitis
• Synovitis , dactylitis , glomerulonephritis , myositis
• Lymph node involvement

8. • Type 3 hypersensitivity reaction
• Occur chiefly in LL
• Occur late in the course of Rx
• Crops of eruthematous Tender papules and nodules
• Mainly On the face and extremities
• Lesions stay for 2-3 days and may turn necrotic – erythema nodosum
necroticans
• Accompanied by fever , malaise & bodyache
• Raised ESR & Polymorph I nuclear leucocytosis

9. .

10. .

11. HISTOPATHOLOGY
• Type 1 REVERSAL REACTION
– Upgrading : increase of lymphocytes, edema , necrosis at centre , reduced BI
– Downgrading :dispersal and spread of granulomas , increased lepra bacilli
• Type 2 ENL
– Infiltration by neutrophils , eosinophils
– Vasculitis and panniculitus
– Bacillary load increased
– Secondary amyloidosis may follow repeated attacks of ENL

12. THANK YOU