1. The picture shows a large patch of paucibacillary (PB) leprosy on the face and ear, with enlargement of the great auricular nerve in the neck (arrowed). A reaction developed suddenly after the start of multidrug therapy (MDT). The previous lesion became swollen, painful and tender. The picture is an important reminder of the importance of nerve involvement in Type 1 reactions. The great auricular shown here happens to have limited clinical significance, but if peripheral nerves in the limbs, or those supplying the eye region are involved, loss of sensation and/or muscle power may occur, sometimes very rapidly. Consult your supervisor or national guidelines on the use of analgesics, splinting or steroids (prednisolone), according to the severity of the reaction. Type 1 reaction.
