01299nas a2200169   4500000000100000008004100001653002000042653002200062653001200084100001200096700001100108245005800119300001000177490000700187520092100194022001401115       2016                            d10aType 1 reaction10aReversal reaction10aleprosy1 aNaafs B1 aHees C00aLeprosy type 1 reaction (formerly reversal reaction).  a37-500 v343 a<p>Nerve damage leading to impairment and permanent disability is the major problem in the course of a leprosy infection. Most of the damage occurs during two types of leprosy reactions, type 1 reaction (T1R) and type 2 reaction (T2R). Timely and adequate treatment may prevent this damage. Particular T1R reactions, however, are often diagnosed too late and are even missed. Clinical symptoms and warning signs are therefore covered, as are the immunology and pathophysiology of nerve damage. The differences between upgrading and downgrading, old terms but still relevant, are explained. Methods to detect reactions and to monitor their treatment are given. Triggering factors, the mechanisms of the reactions, including autoimmunity, and the presence of physical compression are discussed. Treatment over the years is placed in its context, and based on this information a treatment schedule is recommended.</p>
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