The significance of fa cial patches and Type I reaction fo r the development of fa cial nerve damage in leprosy. A retrospective study among 1226 paucibacillary leprosy patients

Twenty-seven patients with borderline leprosy and facial nerve damage of � 6 months duration (36 eyes) were treated with a semistandardized regimen of steroids (the average starting dose was 25-30 mg, duration 5-6 months) on an outpatient basis. Red and raised reactive patches were usually present in the upper malar area or around the eye(s) in patients with recent lagophthalmos. The lid gap was measured in millimetres during gentle and strong closure. After completion of the steroid course 75% of the eyes had complete closure or only a slight gap of � 2 mm on gentle closure. Steroids were fo und to be beneficial and safe, in the dosage that we prescribed.

Summary Thirty-three patients with borderline leprosy who had developed recent (less than 6 months duration) loss of nerve fu nction were treated with a semi-standardized course of corticosteroids, the average initial dose was 25 mg prednisolone daily, and the average duration was 5 months. Treatment was unsupervised and no patient was admitted to hospital. The results were assessed by tests of voluntary muscle power and of sensory fu nction, of the 57 nerves studied, 38 showed marked improvement and none got worse. There were no serious side-effects. Patients were taught exercises to prevent deformity, and residual muscle weakness did not progress to contractures. Corticosteroid treatment is safe enough, and confers sufficient benefit to be used in standard dosage under field conditions. It is common experience that a patient will present himself for treatment because of recent nerve damage (motor or sensory) or signs of incipient nerve damage ('aches and pains' or paraesthesiae), commonly of only a few months duration. In such cases there is a good prospect of improvement if effective treatment for neuritis is instituted promptly. This is even more true of those patients who develop nerve damage during the first years of chemotherapy.In patients with borderline leprosy the nerve damage is caused by the cell mediated immune response to antigens of Mycobacterium leprae, and many patients with recent nerve damage show signs of actual or incipient Type I lepra reaction (reversal reaction) in their skin lesions. The natural history of this reaction (rapid onset, gradual subsidence over a period of months) suggests a logical pattern of steroid treatment. 1 But no 'standard course' has yet won general acceptance. It is often difficult to treat patients with nerve damage under field conditions, indeed, there is a tendency to insist on hospitalization fo r steroid treatment. But patients will probably refuse unless they have severe painful neuritis. Moreover 0305-75 1 8/85/056127+08 SOLOO

Lymphadenopathy is known to be associated with lepromatous leprosy and has also been observed as a feature of type-2 lepra reaction. However, nodular lymph node enlargement is not commonly reported in leprosy patients or as a feature of relapse. We herewith are presenting a case of bacteriological relapse in a patient of lepromatous leprosy treated 22 years before till smear negativity with WHO multidrug therapy (MDT) multibacillary type (MB). She presented with prominent nodular swelling of the cervical group of lymph nodes along with generalized lymphadenopathy, which was mistakenly treated as tubercular lymphadenopathy. A diagnosis of late bacteriological relapse of lepromatous leprosy presenting with prominent lymphadenopathy and ENL was made after relevant investigations. The patient was started on treatment with WHO MDT MB (daily dapsone and clofazimine and monthly rifampicin) and thalidomide (200 mg/day). Nerve pain regressed within 2 weeks of therapy. The lymph nodal swelling regressed within 3 months of starting treatment.

The use of cosmetic camouflage for blemishes on skin of affected people is known to improve their Dermatology Life Quality Index (DLQI). Although the use and benefits of cosmetic camouflage is known and reported in vitiligo, its value in leprosy, where visible skin lesions are a reason for stigma and discrimination, is yet to be explored. A key resolution of the WHO Global Leprosy Strategy 2016-2020 is to stop discrimination and promote inclusion of persons affected by leprosy into society. Improving the DLQI of leprosy patients with the use of cosmetic camouflage is an effort in that direction.Objectives: We undertook this study to examine the change brought about by cosmetic camouflage in the DLQI of leprosy patients with visible skin lesions and, to compare the results with its use in vitiligo, as both are disorders associated with pigment dilution in the skin. Methods: The DLQI score was calculated for 9 consenting leprosy and 14 vitiligo patients at the time of enrolment. All patients were taught the simple technique of cosmetic camouflage of their skin patches on exposed parts of the body, such as face and arms/forearms. The DLQI scoring was calculated again after one month of use of cosmetic camouflage and compared with the baseline value.Results: The mean DLQI improved significantly (p < 0.0001) after the use of cosmetic camouflage in both vitiligo and leprosy groups, indicating the efficacy of camouflage in improving the quality of life. In addition, it was observed that the mean improvement in DLQI was higher in the leprosy group (14.67 ± 3.87) than in the vitiligo group (8.64 ± 2.96), the difference being statistically significant (p < 0.05), suggesting that camouflage has a very high impact on the quality of life in leprosy. Conclusions: Leprosy-related stigma and discrimination are pervasive in almost all cultures of the world. Such stigma affects many aspects of social participation. The WHO global strategy document 2016-2020 advocates inclusion of at least one stigma reduction strategy in all leprosy programme plans. Use of cosmetic camouflage for