A clinicodemographic study of lepra reaction in patients attending dermatology department of a tertiary care hospital in Eastern India

Objective to find the relative prevalence of lepra reactions among leprosy patients attending dermatology out-patient department,the pattern of reactions in different types of leprosy and histopathological features of reaction. methods the study was an institution-based,longitudinal study. a total 316 leprosy cases attended the dermatology out-patient department (opd) of a tertiary care hospital in eastern india. results out of 316 leprosy patients,58 (18.4%) were diagnosed to have lepra reactions and relative prevalence of type 1 and type 2 reaction was 10.4% and 7.9%,respectively. among 58 patients,50 fulfilled the inclusion criteria and were considered for final evaluation. lepra reactions were common in patients over 30 years of age. there was a high male preponderance and the male to female ratio was 4.5:1. more than 60% of the patients belonged to the below poverty line. farmers and laborers were more affected. almost 62% of the patients were literates but most of them had primary education only. type 1 reaction was more common in bt patients (50%),whereas type 2 reaction were more commonly seen in ll patients (32%). erythema and swelling of the skin lesions,neuritis and edema of hands and feet were common features of type 1 reaction. fresh crops of tender evanescent nodules,joint pain,neuritis and fever were common in type 2 reaction. classical histopathological features were present in all the 50 slides examined. in type 1 reaction patients,lymphocytic infiltration (96%),dermal edema (93%),epithelioid cells (78%) and langhans type giant cells (15%) were the common histological findings. edema and foamy macrophages were seen in all cases of type 2 reaction patients. however,polymorphonuclear leucocytes and vasculitis were seen in 21 (95%) and 16 (73%) patients,respectively. conclusion lepra reactions,both type 1 and 2,occur in about 20% of leprosy patients. early detection is warranted to avoid complications.