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Leprosy


-paucibacilliary (<5 skin lesions), multibacillary (>6 skin lesions with or without bacilli)

-upgrading reaction (borderline lepromatous to tuberculoid) usually happens during treatment

Type 1 reactions: 

-downgrading reaction (tuberculoid to lepromatous) usually happens when patients are not on treatment

- both reaction can manifest with erythema and edema

Type 2 reactions: immune complex mediated

- erythema nodosum leprosum and Lucio’s phenomenon

-diagnosis: skin bx with Fite-Faraco stain; can also do slit skin smear but this is less sensitive

-clofazimine: can cause purplish skin

-reversal reactions can be treated symptomatically; treat those a/w neuritis or those with severe reaction with steroids

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