Lepra reactions These are the Sudden episodes of exacerbation occurring during the silent course of leprosy

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

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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