Vara N, Agrawal M, Marfatia Y
Department of Skin and VD, Medical College and SSG Hospital, Raopura, Vadodara, India.
Indian J Lepr. 2010 Oct-Dec;82(4):189-94.
Appearance of new skin and/or nerve lesions during or after fixed duration of multidrug therapy (MDT), in leprosy, is not uncommon. It could be a lesion due to leprosy reaction or relapse. Differentiation is easy in classical reactions both clinically and histopathologically. But, difficult in other situations especially when the relapse cases present with features of reaction at the onset. A study was done to find the reasons for released from treatment (RFT) cases to come to clinic and to follow in terms of clinical and neurological activity, leprosy reactions and deformity progression. Out of them, 14 cases and 86 cases had received paucibacillary (PB) and multibacillary (MB) multidrug therapy respectively. Skin lesions either old or new were noticed in 74% cases which might be due to inactivity or activity were noticed in 74% cases which might be due to inactivity or activity in forms of relapse and reaction. Relapse was seen in 26 cases. Out of these, 10 and 16 cases were previously diagnosed as PB and MB cases respectively. PB cases relapsed into MB cases while MB cases relapsed into MB cases. 46 cases presented with either type 1 or type 2 reaction. After declared as RFT, parasthesia in 34 cases, weakness in 18 cases, paresis and paralytic deformity in 6 cases were seen. So, all the RFT cases need regular follow-up, IEC and physiotherapy to prevent deformity and to diagnose relapse and reactions at the earliest.
在麻风病的多药治疗（MDT）固定疗程期间或之后，出现新的皮肤和/或神经病变并不罕见。这可能是麻风反应或复发导致的病变。在典型反应中，临床和组织病理学上的鉴别都很容易。但在其他情况下则很困难，尤其是当复发病例在发病时表现出反应特征时。开展了一项研究，以找出治疗结束后（RFT）病例前来就诊的原因，并跟踪其临床和神经活动、麻风反应及畸形进展情况。其中，14例和86例分别接受了少菌型（PB）和多菌型（MB）多药治疗。74%的病例出现了新的或旧的皮肤病变，这可能是由于复发和反应形式的静止期或活动期所致。26例出现复发。其中，10例和16例之前分别被诊断为PB和MB病例。PB病例复发为MB病例，而MB病例复发仍为MB病例。46例出现了1型或2型反应。在宣布为RFT后，34例出现感觉异常，18例出现无力，6例出现轻瘫和麻痹性畸形。因此，所有RFT病例都需要定期随访、开展信息教育与宣传及物理治疗，以预防畸形并尽早诊断复发和反应。
