A clinical, epidemiological and histopathological study of leprosy reactions

Abstract

Background: Leprosy reactions are acute emergencies in the otherwise generally indolent course of leprosy. The present study was done to know the epidemiology, clinical manifestations and its histopathological findings.. Methods: A total of 50 patients attending out patient, in the department of Dermatology, venereology and Leprosy at Chigateri Hospital and Bapuji Hospital were included. Detailed history, thorough physical examination and relevant investigations were done. Results: Out of all leprosy outpatients, reactions constituted 16.8%. 66% patients belonged to age group of 21-50 years, with a male to female ratio of 1.94:1. The disease was more common among the illiterates (80%), coolies (52%) and low socio-economic status (76%). Type I (RR) reaction (66%) and Type II (ENL) reaction (34%) which, commonly presented during 1st year of MDT and 2 years of MDT respectively. Borderline spectrum (74%), Anti-leprosy drugs (46%) were major risk factors associated. Erythematous, edematous skin lesions (50.6%); erythematous tender nodules (100%) along with neuritis were most common clinical features in Type I (RR) and Type II (ENL) reactions respectively. Edema (63.6%), lymphocytes (60.6%) and epitheloid cells (54.5%) were major histopathological findings in Type I (RR) reaction where as vasculitis (100%), increased vascularity (82.3%) and PMNL cells (88.2%) in Type II (ENL) reaction. Conclusions: This study emphasizes the need for detailed history, clinical examination and investigations including biopsy for timely recognition of reactions, in order to halt the progress and prevent the permanent damage it causes.