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Interventions for skin changes caused by nerve damage in leprosy.

Liv Merete Reinar1, Louise Forsetlund, Arild Bjørndal

  • 1Unit for Primary Care, Norwegian Knowledge Centre for the Health Services , P O Box 7004, St. Olavs Plass, Oslo, Norway, 0130. liv.merete.reinar@kunnskapssenteret.no

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Topical phenytoin and ketanserin show promise for healing leprosy-related foot ulcers, though evidence quality is low. More high-quality research is needed for effective ulcer prevention and treatment strategies.

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Area of Science:

  • Dermatology
  • Tropical Medicine
  • Wound Healing

Background:

  • Leprosy affects over three million people globally, causing sensory nerve damage and leading to neuropathic ulcers, primarily on the feet.
  • These ulcers represent a significant complication, necessitating interventions for prevention and treatment of secondary skin and limb damage.

Purpose of the Study:

  • To evaluate the efficacy of self-care, dressings, and footwear in preventing and healing secondary skin damage in individuals with leprosy.
  • To synthesize evidence from randomized controlled trials on interventions for leprosy-related ulcers.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) was conducted, searching multiple databases including Cochrane, MEDLINE, EMBASE, CINAHL, and LILACS.
  • Trials included participants with leprosy and peripheral nerve damage, treated with interventions aimed at ulcer healing and prevention.
  • Trial quality was assessed, and data were extracted by two independent reviewers.

Main Results:

  • Eight trials with 557 participants were included, generally of poor quality.
  • Topical ketanserin showed potential benefit over clioquinol cream or zinc paste (RR 6.00).
  • Topical phenytoin demonstrated statistically significant effects favoring ulcer healing compared to saline dressings (SMD -2.34 and -0.79).
  • Footwear interventions (canvas shoes, double rocker shoes) showed limited significant benefits over control options.

Conclusions:

  • Topical ketanserin and phenytoin show potential for treating leprosy ulcers, but evidence is limited by trial quality.
  • Current evidence for other dressings and footwear is equivocal, highlighting a need for rigorous research.
  • Further high-quality randomized controlled trials adhering to current standards are essential for advancing leprosy ulcer management.