Presented by:

Sucipto P Sibala
Indira Pratiwi
Syukri La Ranti

Advisor:
dr. Endang Tri Wahyuni
Supervisor:
dr. Asnawi Madjid , Sp.KK, MARS

Department of Dermatoveneorology
Medical Faculty of Hasanuddin University
Makassar 2010
Introduction
Introduction
 Definition
Reversal reaction :
- Various kind of leprosy reaction
- Caused by increasing of CMI
Epidemiology
 Etiology
 Increase in cell-mediated immunity
(CMI).
Etiology of CMI increase is unclear
 Some factors induce increasing of
CMI--> infections, pregnancy, post-
immunization, and mental distress.
 Pathogenesis
It is triggered by the interaction of CD4-
positive T-helper lymphocytes with antigens
released by M leprae
Reversal reactions are associated with the
infiltration of skin lesions and nerves by
interferon-g and tumour necrosis factor-a-
secreting CD4-positive lymphocytes,
resulting in edema and painful inflammation
Pathogenesis
Diagnosis
 Symptom and Clinical Sign
• Old lesion more active: erithematous,
infiltratif & edema
• Acute neuritis  painfully
• New lesion appear
• There is no systemic symptom
• Sometime prodromal symptom occur
• It happen only in leprosy type BT-BB-BL
Before reaction In reaction
a marked rise in lymphocyte transformation to M. leprae antigens in
vitro, and is therefore thought to be a delayed-type hypersensitivity
(DTH) reaction against M. leprae antigens
 Management
5 aspects management of RR:
•Controlling neuritis
•Stop the damage to the eyes
•Off the leprosy bacillus and stop the
progression of disease
•Physical action
•Analgesic
Treatment of mild reaction
Outpatient, or resting
Analgesics, or sedative
Overcome trigger
If patient in treatment MDT, then MDT
is given continued at a dose not changed
Treatment of severe reactions:
Overcome trigger
Provision of corticosteroid
Analgesic, and sedative
Local Immobilization
Where possible, the patient
hospitalization (in hospital)
Kortikosteriod (Glucocorticoids)
In adults:
• 2 weeks I : 40 mg / day (1 x 8 tab) after the morning meal.
• 2 weeks II : 30 mg / day (1 x 6 tab) after the morning meal
• 2 weeks III: 20 mg / day (1 x 4 tabs) after the morning meal
• 2 weeks of IV : 15 mg / day (1 x 3 tabs) after the morning meal
• 2 weeks V: 10 mg / day (1 x 2 tabs) after the morning meal
• 2 weeks VI: 5 mg / day (1 x 1 tab) after the morning meal
Type I reaction and result after 48 hours of
treatment with prednisolone
Kortikosteriod (Glucocorticoids)
• In children:
The maximum dose of prednisone in
children may not cross 1 mg / kg.
Minimum of 12 weeks of treatment-3
months.
Long-term corticosteroids are stopped
suddenly may cause acute adrenal
insufficiency with symptoms of fever,
myalgia and malaise artralgia.
Corticosteroids, in addition to other
common effects are known, can also cause
exacerbation of the existence of several
diseases, a case of tuberculosis, hepatitis B,
and some gastrointestinal parasites
Clofazimine (Lamprene)
The dose used is usually 300 mg daily,
after 2-4 weeks gradually reduced doses of
corticosteroids.
Side effect:
Discoloration of the skin, from red to dark
gray
Dapsone (DDS)
Dapsone (DDS) 50 mg dose or a dose
greater suppressive effect on the reversal
reaction.
Side effect:
DDS syndrome : dermatitis exfoliatif
lymphadenopathy, hepatosplenomegaly,
fever and hepatitis and can be fatal
Kloroquin
In a mild reaction may be given kloroquin 1
tablet 3 times for 3-5 days while antilepra
allowed to continue if necessary given the
analgesic and sedative.
Methotrexate
Low-dose methotrexate (5 to 7.5 mg /
week)
Treatment with methotrexate should be
discontinued if stomatitis and diarrhea
appear as hemorrhagic enteritis and
perforation may occur. Methotrexate
should not be gived in the first trimester of
pregnancy as reported to cause abortion.
If surgery performed after corticosteroid
therapy for 48 hours has not been visible
reduction in pain or no recovery of nerve
function.
 Prognosis
The sooner treated, the prognosis is better
Irreversible peripheral nerve: Claw-hand
or facial paralysis.
Reaction reversal can lead to relapse.