Leprosy reactions: 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 reactions

Sample item

A patient with borderline tuberculoid leprosy, a few weeks into treatment, develops erythema and swelling of his existing skin patches and a sudden foot drop and a tender common peroneal nerve. What is this reaction?

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

The answer and the reasoning

D. Type 1 (reversal) lepra reaction

A type 1 reaction occurs in borderline leprosy, typically after starting therapy, when cell-mediated immunity shifts. Existing lesions become red and oedematous, and acute nerve damage is the major risk, so early high-dose corticosteroids are needed to protect nerve function.

Option by option

  • A. Type 2 lepra reaction (erythema nodosum leprosum)

    Erythema nodosum leprosum produces new crops of tender nodules with systemic illness, mainly in lepromatous disease.

  • B. Lucio phenomenon

    Lucio phenomenon is a necrotising vasculitis with ulcers in diffuse lepromatous leprosy.

  • C. Histoid leprosy

    Histoid leprosy is a variant with firm nodules in lepromatous patients, usually after relapse or dapsone resistance.

  • D. Type 1 (reversal) lepra reaction (correct)

    Correct. Inflamed pre-existing patches with new neuritis are the hallmark of a reversal 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, Type 1 (reversal) lepra reaction. A type 1 reaction occurs in borderline leprosy, typically after starting therapy, when cell-mediated immunity shifts.

Why is "Type 2 lepra reaction (erythema nodosum leprosum)" not the answer?

Erythema nodosum leprosum produces new crops of tender nodules with systemic illness, mainly in lepromatous disease.

Why is "Lucio phenomenon" not the answer?

Lucio phenomenon is a necrotising vasculitis with ulcers in diffuse lepromatous leprosy.

Why is "Histoid leprosy" not the answer?

Histoid leprosy is a variant with firm nodules in lepromatous patients, usually after relapse or dapsone resistance.

What concept does this question test?

It tests Leprosy reactions in Dermatology. Existing lesions become red and oedematous, and acute nerve damage is the major risk, so early high-dose corticosteroids are needed to protect nerve function.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 reactions?

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.