A patient with borderline tuberculoid (BT) leprosy on MDT develops sudden onset painful swelling of leprosy patches with new patches appearing, accompanied by nerve pain and tenderness. Systemic symptoms are absent. This reaction type and its management are:
- A Type 2 reaction (ENL) — managed with thalidomide
- B Type 1 reaction (reversal) — managed with prednisolone ✓
- C Lucio phenomenon — managed with clofazimine
- D Downgrading reaction — managed by stopping MDT
Correct answer: B. Type 1 reaction (reversal) — managed with prednisolone
Explanation
Type 1 lepra reaction (reversal reaction) occurs in borderline leprosy (BT, BB, BL) due to a sudden increase in cell-mediated immunity. Clinically there is sudden upgrading of existing patches (become erythematous, edematous), new patches, and acute neuritis. Treatment is oral prednisolone 40–60mg/day tapered over 3–6 months; MDT must be continued. Thalidomide is the drug of choice for Type 2 (ENL), which occurs in lepromatous/BL leprosy with systemic features and nodular erythema.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.