A patient with leprosy develops reversal reaction (Type 1 lepra reaction) during multidrug therapy. The correct management is:

• A Stop MDT; start thalidomide
• B Continue MDT; add prednisolone 40–60 mg/day tapered over 3–6 months ✓
• C Continue MDT; start clofazimine and increase its dose
• D Stop MDT; start high-dose dapsone monotherapy

Explanation

Type 1 (reversal) reaction is a cell-mediated immune upgrading reaction involving skin and nerve inflammation; it must be treated promptly to prevent irreversible nerve damage. MDT is always continued during the reaction. Systemic corticosteroids (prednisolone starting at 40–60 mg/day and tapered over 3–6 months) are the treatment of choice. Thalidomide is used for Type 2 (ENL) reactions, not Type 1, and has teratogenicity concerns. Clofazimine has mild anti-inflammatory action but is insufficient alone for reversal reactions.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.