Dr. Pannikar Replies
To the Editor:
I am very grateful to Professor Sehgal for his very valuable comments. He has added new dimensions to this issue, such as differentiation between upgrading and downgrading reactions, downgrading reaction and downgrading per se and relapse or type 1 reaction (refer to Tables 1, 2, 3).
I still feel that clinically it is difficult to differentiate between relapse and late reversal reaction, especially under field conditions. It is important to find simple tools to differentiate these two phenomena because management of these two is different. I suggest that under field conditions both of these phenomena should be given a "therapeutic trial" with steroids and, depending on the response, may be categorized into two groups: the group responding favorably to steroids-reversal reaction; the group not showing any response -relapse. In my paper, I have already emphasized the need for a controlled, prospective multicentric study to elucidate these differences.
I once again thank Professor Sehgal for his comment.
- V . K. Pannikar, M.B.B.S.,
M.Sc.(Lond.)
Ag. Head
Epidemiology and Leprosy Control
Schieffelin Leprosy Research & Training Centre, Karigiri
North Arcot District
Tamil Nadu 632106, India