Management of leprosy complications

Treat with steroids, prednisolone 30-40 mg daily to start with, taper down to 20 mg
daily in 2 months. This daily dose should be maintained for some months (PB 1-2
months, MB 2-4 months or sometimes longer according to clinical assessments).
Thereafter the dosage can be further tapered down to zero in 2 months.
- Make sure that treatment is continued for a sufficient time!
- Check for intercurrent infections (TB, strongyloides).
Erythema Nodosum Leprosum
- Treat mild ENL, i.e. without nerve, eye or genital involvement with
acetyl salicylicum 1000 mg three times daily for 1-2 weeks.
- Treat severe ENL, i.e. a sick patient with nerve, eye, or genital
involvement, with steroids. Start prednisolone at 80 - 100 mg daily
for 2 days and taper off in 2 weeks. You may need to repeat this.
- Check for intercurrent infections!
- TB may complicate ENL!
- In countries where thalidomide is available 100 - 400 mg once daily
may be given for 1-2 weeks.
- Do not give thalidomide to pregnant women or women who do not
have 100% safe contraception!!! Thalidomide causes severe
deformities in the unborn child!
Ulceration and deformity
- Wounds should be cleaned and covered. Superficial wounds can be
covered with zinc adhesive sticking plaster which should be
renewed after 1-2 weeks. Hyperkeratotic rims should be trimmed.
- Do not use bulky bandages on the feet. These give local pressure
when walked upon and the wound will not heal!
- Use antibiotics only when there is cellulitis.
- Further deformity should be prevented by daily care by the patient: daily
inspection, soaking and oiling, trimming of cracks and softening of the skin by
applying 15% salicylic acid in vaseline. Digits should be stretched actively
and passively to prevent further contractures. For the unblinking eye protective
glasses during the day and a soft cover with vaseline during the night is necessary.
The patient has to learn to consciously blink regularly in order to moisten the eye.
Warning: Complications, reactions and further deformities
may occur for years after completion of antibacterial
WHO treatment. Patients should be informed about this and
proper treatment should be started immediately.