Complications

Deformities: When superficial peripheral

• Facial nerve _ facial palsy

• Ulnar nerve _ ulnar claw hand

• Median nerve _ median claw hand

• Lateral popliteal nerve _ foot drop

• Posterior tibial nerve _ claw foot

• Radial nerve _ wrist drop _ (rare)

Trophic ulcers: occur because of the loss of sensation of touch, temperature and pain and also as a result of pressure necrosis. They mainly occur over the pressure bearing areas of the sole of foot. They occur as chronic punched out ulcers with pale overhanging edges, a necrotic floor and a rim of hyperkeratosis around the ulcer. Treatment of trophic ulcers includes relief of pressure from the area, debridement of ulcer, and suitable antibiotics to combat the secondary infection.

Reactional states : A disturbance in the immunologic equilibrium sets in motion the reactional states. The precipitating factors are intercurrent infection, intercurrent infestation, surgical trauma, vaccination, hormonal influences as in pregnancy and puerperium and sometimes drugs like Dapsone.

There are two types of reactions

Type I reaction: This is a hypersensitivity reaction which occurs in the early phase of the disease. It occurs mainly in Tuberculoid and borderline types of leprosy. When it results in gain in immunity it is known as reversal reaction and when it results in decline of immunity it results in down-grading reaction.

In a reversal reaction, not all the existing lesions are involved, no new lesions appear and the borders of the lesions become more well defined with the lesions becoming more infiltrated.

In a down grading reaction nearly all the lesions are involved, new lesions will appear and the well defined nature of the lesions become less prominent with a generalised oedema and infiltration surrounding them.

Type II reaction: This occurs as a result of soluble circulating immune complexes. This is seen in the later phase of the disease and is encountered in borderline lepromatous and lepromatous leprosy. Clinical features are characterized by erythema nodosum leprosum which are painful, tender, dome shaped, subcutaneous nodules mainly seen in the trunk and proximal limbs.Lesions occur in crops each lasting a few days. In severe cases they may ulcerate. Superficial lymph glands become painful and tender. There may be associated neuritis, orchitis, iridocyclitis , dactylitis and synovitis. Severe constitutional symptoms occur.

Treatment include:

• Prevention and treatment of precipitating factors

• Drugs for symptomatic therapy

• Drugs that have some specific action like chloroquine in Type I reactions and Thalidomide in Type II reactions.

• Cortico steroids provide dramatic relief but there is a danger of rebound phenomenon and exacerbation of the disease

• Clofazimine has an antiinflammatory and antileprotic effect.