Leprosy (Hansen’s Disease) (Onivola RAHAROLAHY MD, Madagascar) [World Skin Health Day 2022 – Madagascar]

La Lèpre (Hansen’s disease) [Video on Demand] : LINK

Abstract

Type 2 leprosy reaction is an immunological complication of leprosy. The most common form is erythema nodosum leprosum (ENL). It is most likely to occur when cellular immunity levels are low. Its overall incidence has decreased markedly since multi-drug therapy for leprosy were implemented. Systemic involvement can be severe. We aim to describe the clinical and therapeutic aspects of this type of reaction in patients treated for leprosy at the Dermatology Unit of the University Hospital of Befelatanana, Antananarivo.

Thirty four cases of type 2 leprosy reactions we rerecorded over a period of 7 years. Sex ratio M/F was 3.25. The mean age was 36 years old, ranging from 11 to 72 years. Leprosy patients were seen late with an average delay of 16.3 months. Type 2 reaction occurred in 29.4% of cases (n=10) before initiation of leprosy multi-drug therapy, in 14.7% of cases (n=5)after completion of therapy. For other patients, it occurred by 4.5 months of treatment. ENL flare-upslasted on average 13.6 months. It wassurprisinglymore common in borderline lepromatous (BL) than in lepromatous (LL). Erythema nodosum leprosum predominated with 55.8% of cases (n=19). Three patients met clinicalcriteria for Lucio’s phenomenon. Associated clinical features were mainly general symptoms, neuritis and arthritis. A case of renal involvement was complicated by fatal secondary renal amyloidosis. The bacillary index was greater than 3+in 58.8% of cases (n=20). Acute attacks of ENL (n=24) predominated over chronic (n=9) or recurrent (n=1) forms. Systemiccorticosteroids, clofazimine and doxycycline were the most prescribed drugs. Favourable evolution under treatment was obtained for 11 patients, with functional sequelae in the 23 remaining patients. 

Complications of leprosy, including ENL, can occur despite treatment. Clinical polymorphismmay further confound the diagnosis, compromising the prognosis and increasing the socio-economic burden of leprosy. 

CV of the presenter

-Dr. Onivola Raharolahy is a board certified Dermatologist-Venerologist

-Member of the Madagascar Society of Dermatology (SOMADER)

-Author of over 25 scientific articles

Presentation and description by Dr Onivola RAHAROLAHY MD (Madagascar) [French; World Skin Health Day 2022 -Madagascar] (To find the presentation simply use the filter buttons from the event homescreen)

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