Reactions in Hansen’s Disease

Lepra reactions are acute exacerbations of disease occurring during the natural course of leprosy and can occur before, during, or after treatment. The immunopathogenesis of lepra reactions is still being elucidated. Reactions can affect the skin, nerves, eyes, and other internal organs. Reactions constitute the main event by which leprosy causes nerve damage and disability that is the reason for much of the fear and stigma associated with the disease. Early diagnosis and effective management of reactions is thus central to preventing disability. The early recognition of reactions demands clinical acumen, and their effective management requires careful judgement on the part of the healthcare provider. This chapter discusses lepra reactions, their clinical features, pathogenesis, histopathology, differential diagnosis, and management.