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
Volume 2, Issue 4, July 2014, Pages: 86-89
Received: Jul. 28, 2014; Accepted: Aug. 11, 2014; Published: Aug. 20, 2014
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Author
Delwar Hossain, Department of Dermatology and Venereology, University of Science and Technology Chittagong (USTC), Foy’s Lake, Khulsi, Chittagong, Bangladesh
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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.
Keywords
Leprosy, Reversal Reaction, Reacting Facial Patch, Management, Tacrolimus and Prednisolone
To cite this article
Delwar Hossain, 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. Vol. 2, No. 4, 2014, pp. 86-89. doi: 10.11648/j.ajcem.20140204.16
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.
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