Question

A patient who has been on MBMDT presents with inflammation over pre-existing lesions and nerve involvement. What will be the best approach of treatment?

• A. Stop ALT and start steroids
• B. Stop ALT and start thalidomide
• C. Continue ALT and start steroids
• D. Continue ALT and give thalidomide

Answer 1

The Correct Option is C

In the context of dermatology, a patient undergoing MBMDT (Multibacillary Multidrug Therapy) for leprosy may experience a reactional state known as "lepra reaction." These reactions can manifest as inflammation over existing lesions and nerve involvement, which can be particularly concerning.

The two main types of lepra reactions are Type 1 (reversal reaction) and Type 2 (erythema nodosum leprosum). In both situations, management strategies need to balance the continuation of antimycobacterial treatment with the control of inflammatory symptoms.

Given the presented options, the correct course of action is:

• Continue ALT: It is crucial to continue the Antileprosy Therapy (ALT) to control the underlying Mycobacterium leprae infection, preventing further progression and transmission.
• Start Steroids: Corticosteroids, such as prednisone, are the first-line treatment for managing inflammatory reactions in leprosy. They help reduce nerve inflammation and damage during lepra reactions.

Therefore, the best approach is to simultaneously manage the bacterial infection and control the inflammatory symptoms using steroids.