Author details

dependent on corticosteroids. The total duration of clofazimine therapy should not exceed

Corticosteroids and thalidomide are the mainstay of therapy in the control of type II reaction. Selective cytokine inhibitors and phosphodiesterase type-4 inhibitors with potential TNF-

In general, cutaneous drug reactions, local skin infections, relapses, diabetes, Bell's palsy, rheumatoid arthritis, rheumatic fever, and disc prolapse must be taken into consideration in differential diagnosis. It may manifest as various cutaneous drug reactions such as urticarial, lichenoid, exanthematous reactions, erythema nodosum, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. The patients usually suffer from itching and burning in some of these lesions, whereas these symptoms are not observed in patients with leprosy. Furthermore, new skin lesions do not resemble preexisting lesions. Localized skin infections developing in patients with leprosy are often confined to a particular body site. The lesions do not occur bilaterally and medical history is often remarkable for trauma or insect bites that could cause an infection. New lesions appear if relapse occurs, and this often has an insidious course rather than a severe clinical course. Reaction often occurs within the first 3 years after initiation of leprosy therapy and old lesions exhibit acute pain and tenderness. Diabetic patients are prone to infections and development of peripheral neuropathy. Furthermore, regulation of blood glucose is impaired upon administration of corticosteroids. All patients must be screened for diabetes and referred to an advanced facility if diabetes is diagnosed. Bell's palsy may mimic facial paralysis caused by leprosy reactions. These patients do not have nerve thickening, sensory loss along the nerve projection, and hypopigmented skin lesions. This condition is better evaluated by the ophthalmologists. In Bell's paralysis, widening of palpebral fissure is not associated with the drop of lower eyelid. It occurs in women at childbearing age with rheumatoid arthritis, joint pain, joint deformities, fever, skin rash, and multiple organ involvement. Rheumatoid factor is almost always found to be elevated. However, referral to an advanced facility may be sometimes required to differentiate rheumatoid arthritis from leprosy reaction. Patients with rheumatic fever are usually young patients with fever, joint pain, and skin rash for a short period. These patients have high antistreptolysin O titers and valvular involvement can be found that cause murmur on auscultation. Patients with disc prolapse may present with acute onset of neuropathy in the extremities. Patients often report weight lifting in the early periods or stretching in the back. These patients do not show skin lesions or nerve thickening [23, 28].

The reactions can contribute to further deterioration of the quality of life in leprosy. Early diagnosis of reactions can prevent nerve damage and provide early intervention to systemic

alpha activity but without T-cell activating effect are new drugs [17].

12 months [18].

5. Conclusion

complications.

4. Differential diagnoses

88 Hansen's Disease - The Forgotten and Neglected Disease

Leyla Bilik, Betul Demir\* and Demet Cicek

\*Address all correspondence to: drbkaraca@yahoo.com

Department of Dermatology, Firat University Hospital, Elazig, Turkey
