Treatment of sever ulnar neuritis in borderline tuberculoid leprosy is -

Lepra reaction During the course of leprosy, immunologically mediated episodes of acute or subacute inflammation known as reactions may occur. Because peripheral nerve trunks are often involved, unless reactions are promptly and adequately treated, such episodes can result in permanent deformities. Type 1 (Reversal Reaction) 1. Delayed hypersensitivity. 2. Occurs in both PB and MB cases in unstable types like BT.BB.BL. 3. Skin lesions suddenly become reddish, swollen, warm, painful, and tender. New lesions may appear. 4. Nerves close to skin may be enlarged, tender.and painful (neuritis) with loss of its functions (loss of sensation and muscle weakness) which may appear suddenly. 5. Other organs - not affected. 6. General symptoms - not common. Treatment of Lepra reactions (moderate to severe cases) It includes bed rest, rest to affected nerves by splint, analgesics, prednisolone. Each case of reaction should be assessed for his/her fitness to put on prednisolone as per check list given above Prednisolone tablets issued must be entered in 'Prednisolone card'. Tapering of prednisolone may be done according to its response. Patient must be instructed on salt restriction, no prednisolone intake on empty stomach and repoing adverse effects/symptoms immediately. Adding Clofazimine for Type II reaction may be extremely useful for reducing or withdrawing coicosteroids in patients who have become dependent on them. Total duration of Clofazimine therapy should not exceed 12 months. If a patient develops lepra reaction during the treatment, do not stop MDT (rather complete the course of MDT). Lepra reactions, which occur after completion of treatment, should also be managed as mentioned earlier. MDT should not be restaed for such cases. Response to treatment should be monitored and assessed, including check on adverse effects of prednisolone. Before staing the steroid treatment, the patient should be asked questions about epigestric pain and diarrhoea, with or without blood and or mucous; and examined for fungal infection, scabies, and worm infestations, as all these conditions may be made worse by steroids. Treatment of all these conditions can be staed at the same time as steroids are staed. Before staing the steroid treatment the patient should be explained the reason for treatment; the duration of the treatment; impoance of taking daily dose and that the treatment should not be stopped suddenly (the dosage is decreased gradually) and impoance of completing the full course of treatment; and possible side-effects. Ref: Park 25th edition Pgno : 332-347