Type 1 leprosy reversal reaction treated with topical tacrolimus along with systemic corticosteroids

An 11-year-old black Haitian boy presented with borderline lepromatous leprosy and was treated with rifampicin, dapsone, and clofazimine. After 4 months he developed a severe type 1 reversal reaction without nerve involvement. He was started on prednisolone (1 mg/kg daily). After 4 weeks of treatment with corticosteroids, his condition did not improve and the lesions remained painful. The patient was given a therapeutic trial with twice daily application of topical tacrolimus 0.1% ointment. The result was a dramatic improvement in the skin lesions. The patient′s condition was maintained by topical tacrolimus therapy, with healing of all skin lesions. The prednisolone dose was then tapered to zero over a period of 12 weeks. To the best of our knowledge, this is the first report of the efficacy of topical tacrolimus in the treatment of type 1 leprosy reaction.