The use of corticosteroids in leprosy

Abstract

The principles of the use of corticosteroids to treat reaction in leprosy can be defined as: Reversal reaction: Corticosteroids should be employed in initial high dosage gradually tapering off, the course lasting for weeks or months continuously. Erythema nodosum leprosum: Corticosteroids should be employed in repeated courses of about 2 weeks, each course being very rapidly tapered off. Neuritis: In the absence of skin reaction, neuritis should be considered as a manifestation of reaction in the nerve, and treated as for the appropriate skin reaction. The longer steroid treatment for neuritis is delayed, the less satisfactory is the result likely to be. Patients with ENL who require frequent, almost continuous courses of corticosteroids for periods of months should receive continuous clofazimine and/or thalidomide. These drugs will make it possible to reduce or discontinue the use of corticosteroids. In addition to their systemic use, corticosteroids can be used as topical applications in the treatment of iritis, iridocyclitis and scleritis. Depot injections, which can be administered subconjunctivally, are also available. A further use of corticosteroids is by local injection around inflamed nerves. Such injections usually take form of a local anaesthetic/hyaluronidase/hydrocortisone mixture and may be repeated daily if necessary. They may be particularly valuable in the managment of severe mononeuritis, but no reports of long-term functional results are available.