American Journal of Clinical and Experimental Medicine

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Tacrolimus in the Management of Large Facial Patch with Recurring Reversal Reaction: Outcome of a Pilot Clinical Trial Study on 5 Patients

Received: 28 July 2014    Accepted: 11 August 2014    Published: 20 August 2014
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Abstract

Background: Inflamed large facial patch, being compromising the appearance and beauty of a patient, is a source of embarrassment and distress, and affects anti-leprosy drive adversely in many ways in the field situation. Its management with oral prednisolone alone, the mainstay of treatment for reversal reaction, proved disappointing. Objective: To see whether topical tacrolimus will be helpful in managing those patients. Methodology: We treated five adult patients with recurring reversal reaction in large facial patch with tacrolimus 0.1% ointment, twice daily and lower dose oral prednisolone for twelve months during March, 2012-February, 2013. Result: Complete remission was achieved in all cases. No side effects of whatsoever was seen in any patient. No recurrence of reaction is seen in any patient till to date. Conclusion: Tacrolimus ointment and lower dose prednisolone was found helpful in managing patients with recurring reversal reaction in large facial patch.

DOI 10.11648/j.ajcem.20140204.16
Published in American Journal of Clinical and Experimental Medicine (Volume 2, Issue 4, July 2014)
Page(s) 86-89
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Leprosy, Reversal Reaction, Reacting Facial Patch, Management, Tacrolimus and Prednisolone

References
[1] Job CK. Pathology of leprosy. In: Hastings RC (ed). Leprosy, 2nd edn. Churchill Livingstone, Edinburgh, 1994; pp. 193-234.
[2] Richardus JH, Finlay K, Croft RP and Smith WCS. Nerve function impairment in leprosy at diagnosis and completion of MDT: a retrospective cohort study of 786 patients in Bangladesh. Lepr Rev, 1996; 67: 297-305.
[3] Lockwood DNJ. Clinical features and outcome of reversal (type 1) reactions in Hyderabad, India. J Int Lepr, 1993; 61: 8-15.
[4] Becx-Bleumink M, Berhe D. Occurrence of reactions, their diagnosis and management in leprosy patients treated with multidrug therapy: experience in the leprosy control program of the All Africa Leprosy and Rehabilitation Training Center (ALERT) in Ethiopia. Int J Lepr, 1992; 60: 173-184.
[5] Guillermo Biosca, Sonia Casallo and Rogelio Lopez-Velez. Methotrexate treatment for type 1 (reversal) leprosy reactions. Clin Infect Dis, 2007; 45 (1): e7-e9. Doi: 10.1086/518699.
[6] Frankel RI, Mita RT, Kim R and Dann FJ. Resolution of type 1 reaction in multibacillary Hensen’s disease as a result of treatment with cyclosporine. Int J Lepr Other Mycobact Dis, 1992; 60: 8-12.
[7] Marlowe SN, Hawksworth RA, Butlin CR, Nicholls PG and Loockwood DN. Clinical outcomes in a randomized controlled study comparing azathioprine and prednisolone versus prednisolone alone in the treatment of severe leprosy type 1 reactions in Nepal.Trans R Soc Trop Med Hyg, 2004; 98: 602-9.
[8] Gilles Safa, Laure Darrieux, Alain Coic, Laurent Tisseau. Type 1 leprosy reversal reaction treated with topical tacrolimus along with systemic corticosteroids. Indian J Med Sci, 2009; 63 (8): 359-362.
[9] Rose P, Waters MFR. Reversal reactions in leprosy and their management. Lepr Rev, 1991; 62: 113-121.
[10] Roche PW, LeMaster J, Butlin CR. Risk factors for type 1 reactions in leprosy. Int J Lepr, 1997; 65: 450-55.
[11] Swierkot J, Szechinski J. Methotrexate in rheumatoid arthritis. Pharmacol Rep, 2006; 58: 473-92.
[12] Ochoa MT, Stenger S, Sieling PA et al. T-cell release of granulysin contributes to host defense in leprosy. Nat Med, 2001; 7: 174-179.
[13] Cooper RL, Mueller C, Sinchaisri T-A et al. Analysis of naturally occurring delayed type hypersensitivity reactions in leprosy by in situ hybridization. J Exp Immunol, 1989; 169: 1565-81.
[14] Sullivan L, Sano S, Pirmez C et at. Expression of adhesion molecules in leprosy lesions. Infect Immun, 1991; 59: 4154-60.
[15] Gupta AK, Adamiak A, Chow M. Tacrolimus: A review of its use for the management of dermatoses. J Eur Acad Dermatol Venereol, 2002; 16: 100-114.
[16] Naafs B. Treatment of reactions and nerve damage. Int J Lepr, 1996; 64: S21-28.
Author Information
  • Department of Dermatology and Venereology, University of Science and Technology Chittagong (USTC), Foy’s Lake, Khulsi, Chittagong, Bangladesh

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    Delwar Hossain. (2014). Tacrolimus in the Management of Large Facial Patch with Recurring Reversal Reaction: Outcome of a Pilot Clinical Trial Study on 5 Patients. American Journal of Clinical and Experimental Medicine, 2(4), 86-89. https://doi.org/10.11648/j.ajcem.20140204.16

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    ACS Style

    Delwar Hossain. Tacrolimus in the Management of Large Facial Patch with Recurring Reversal Reaction: Outcome of a Pilot Clinical Trial Study on 5 Patients. Am. J. Clin. Exp. Med. 2014, 2(4), 86-89. doi: 10.11648/j.ajcem.20140204.16

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    AMA Style

    Delwar Hossain. Tacrolimus in the Management of Large Facial Patch with Recurring Reversal Reaction: Outcome of a Pilot Clinical Trial Study on 5 Patients. Am J Clin Exp Med. 2014;2(4):86-89. doi: 10.11648/j.ajcem.20140204.16

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  • @article{10.11648/j.ajcem.20140204.16,
      author = {Delwar Hossain},
      title = {Tacrolimus in the Management of Large Facial Patch with Recurring Reversal Reaction: Outcome of a Pilot Clinical Trial Study on 5 Patients},
      journal = {American Journal of Clinical and Experimental Medicine},
      volume = {2},
      number = {4},
      pages = {86-89},
      doi = {10.11648/j.ajcem.20140204.16},
      url = {https://doi.org/10.11648/j.ajcem.20140204.16},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajcem.20140204.16},
      abstract = {Background: Inflamed large facial patch, being compromising the appearance and beauty of a patient, is a source of embarrassment and distress, and affects anti-leprosy drive adversely in many ways in the field situation. Its management with oral prednisolone alone, the mainstay of treatment for reversal reaction, proved disappointing. Objective: To see whether topical tacrolimus will be helpful in managing those patients. Methodology: We treated five adult patients with recurring reversal reaction in large facial patch with tacrolimus 0.1% ointment, twice daily and lower dose oral prednisolone for twelve months during March, 2012-February, 2013. Result: Complete remission was achieved in all cases. No side effects of whatsoever was seen in any patient. No recurrence of reaction is seen in any patient till to date. Conclusion: Tacrolimus ointment and lower dose prednisolone was found helpful in managing patients with recurring reversal reaction in large facial patch.},
     year = {2014}
    }
    

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    T1  - Tacrolimus in the Management of Large Facial Patch with Recurring Reversal Reaction: Outcome of a Pilot Clinical Trial Study on 5 Patients
    AU  - Delwar Hossain
    Y1  - 2014/08/20
    PY  - 2014
    N1  - https://doi.org/10.11648/j.ajcem.20140204.16
    DO  - 10.11648/j.ajcem.20140204.16
    T2  - American Journal of Clinical and Experimental Medicine
    JF  - American Journal of Clinical and Experimental Medicine
    JO  - American Journal of Clinical and Experimental Medicine
    SP  - 86
    EP  - 89
    PB  - Science Publishing Group
    SN  - 2330-8133
    UR  - https://doi.org/10.11648/j.ajcem.20140204.16
    AB  - Background: Inflamed large facial patch, being compromising the appearance and beauty of a patient, is a source of embarrassment and distress, and affects anti-leprosy drive adversely in many ways in the field situation. Its management with oral prednisolone alone, the mainstay of treatment for reversal reaction, proved disappointing. Objective: To see whether topical tacrolimus will be helpful in managing those patients. Methodology: We treated five adult patients with recurring reversal reaction in large facial patch with tacrolimus 0.1% ointment, twice daily and lower dose oral prednisolone for twelve months during March, 2012-February, 2013. Result: Complete remission was achieved in all cases. No side effects of whatsoever was seen in any patient. No recurrence of reaction is seen in any patient till to date. Conclusion: Tacrolimus ointment and lower dose prednisolone was found helpful in managing patients with recurring reversal reaction in large facial patch.
    VL  - 2
    IS  - 4
    ER  - 

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