Prevention of repeated episodes of type 2 reaction of leprosy with the use of thalidomide 100 mg/day

Abstract

BACKGROUNDLeprosy can have its course interrupted by type 1 and 2 reactional episodes, the last named of erythema nodosum leprosum (ENL). Thalidomide has been the medication of choice for the control of ENL episodes since 1965.OBJECTIVESThese episodes can repeat and cause damages to the patient. In order to prevent these episodes, an extra dose of 100 mg/day thalidomide was used during six months, followed by a follow-up period of six more months after thalidomide discontinuation.METHODSWe included 42 patients with multibacillary (MB) leprosy who had episodes of ENL. They were male and female patients aged between 18 and 84 years.RESULTSOf the 42 patients, 39 (92.85%) had the lepromatous form and three (7.15%) had the borderline form. We found that 100% of patients had no reactional episode during the use of the drug. During the follow-up period after thalidomide discontinuation, 33 (78.57%) patients had no reactional episode and nine (21.43%), all of them with the lepromatous form, had mild episodes, which were controlled using non-steroidal anti-inflammatory. There were no thalidomide-related side effects.CONCLUSIONA maintenance dose of 100 mg/day of thalidomide showed to be effective to prevent repeated type 2 reactional episodes of ENL.

Incapacidades físicas em pessoas que concluíram a poliquimioterapia para hanseníase em Vitória da Conquista, Bahia, Brasil

“…Isto se deve à cronicidade e complicações da doença, com consequente limitação funcional, impacto na realização de atividades, participação social 8,9,15 e, até mesmo, na sustentabilidade econômica individual e familiar, dada a necessidade de afastamento temporário ou até mesmo permanente dos serviços em que trabalham. 38,39 O padrão de zona de moradia assemelhase ao encontrado na literatura 9,33,40 supondo que o maior número de casos residentes na zona urbana proporciona, em tese, um melhor acesso aos serviços de saúde. 15 mensal em SM e o analfabetismo são as condições socioeconômicas mais precárias se apresentam como realidade da população estudada com incapacidades físicas, ainda que com significância estatística somente para a variável renda escolaridade, se mostra compatível com pesquisas realizadas na região Nordeste brasileira 13,14,15,33,34,40 e outras realizadas na Índia e Indonésia.…”

Treatment and Evaluation Advances in Leprosy Neuropathy

“…Small clinical trials have shown that methotrexate administered with low-dose corticosteroids is effective and safe as a corticosteroid-sparing agent. Pentoxifylline, which inhibits tumor necrosis factor (TNF) production, has also been used to treat ENL [120][121][122][123]. Inhibitors of TNFα such as infliximab have been used in cases of severe ENL refractory to other agents [124].…”

The oral cavity in leprosy: what clinicians need to know

“…Reactional episodes constitute an exacerbated inflammatory process resulting from changes in the balance between the host and M. leprae , which may occur before, during, or after the treatment of leprosy (Foss and Motta, ). There are two main types of reactional episodes: the reverse reaction (RR) or type 1, and the erythema nodosum leprosum (ENL) or type 2 (Foss et al , ; Moraes et al , ; Putinatti et al , ; Reibel et al , ). Their pathophysiological mechanisms are uncertain and are possibly associated with the inflammatory reaction related to conditions such as immunization, stress, pregnancy, puberty, childbirth, surgery, use of drugs such as antibiotics, potassium iodide, progesterone, and vitamin A, and infectious diseases, including viral or bacterial recurrent infections (Sarno et al , ; Foss et al , ; Lastoria and Abreu, ; Cortela et al , ).…”