Leprosy: downgrading reaction: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Leprosy: downgrading reaction

Sample item

A patient with untreated borderline tuberculoid leprosy develops many new, smaller lesions with increasing bacillary load on smear. Which term describes this immunological shift?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Downgrading reaction towards the lepromatous pole

In unstable borderline leprosy, falling cell-mediated immunity in untreated patients moves the disease toward the lepromatous pole (downgrading), with more lesions and higher bacillary index. Reversal reaction is the opposite, upgrading toward the tuberculoid pole, typically after starting treatment. Both are type 1 reactions in the borderline spectrum.

Option by option

  • A. Histoid transformation

    Histoid leprosy is a nodular lepromatous variant after dapsone monotherapy.

  • B. Lucio phenomenon

    Lucio phenomenon occurs in diffuse lepromatous leprosy with necrotising vasculitis.

  • C. Reversal (upgrading) reaction

    Reversal reaction is an immune improvement, usually during treatment.

  • D. Downgrading reaction towards the lepromatous pole (correct)

    Correct. Falling immunity in untreated borderline disease is a downgrading reaction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is D, Downgrading reaction towards the lepromatous pole. In unstable borderline leprosy, falling cell-mediated immunity in untreated patients moves the disease toward the lepromatous pole (downgrading), with more lesions and higher bacillary index.

Why is "Histoid transformation" not the answer?

Histoid leprosy is a nodular lepromatous variant after dapsone monotherapy.

Why is "Lucio phenomenon" not the answer?

Lucio phenomenon occurs in diffuse lepromatous leprosy with necrotising vasculitis.

Why is "Reversal (upgrading) reaction" not the answer?

Reversal reaction is an immune improvement, usually during treatment.

What concept does this question test?

It tests Leprosy: downgrading reaction in Dermatology. Reversal reaction is the opposite, upgrading toward the tuberculoid pole, typically after starting treatment. Both are type 1 reactions in the borderline spectrum.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Leprosy: downgrading reaction?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.