Tumor necrosis factor: status in reactions in leprosy before and after treatment

Int J Dermatol. 1993 Jun;32(6):436-9. doi: 10.1111/j.1365-4362.1993.tb02816.x.


Background: Tumor necrosis factor-alpha (TNF) is an important mediator of immunologic responses to chronic infections.

Method: Sera from 25 patients with acute reactions (6 with type 1 upgrading, 8 with type 1 downgrading, and 11 with type 2 reaction) were assayed for TNF before treatment and after clinical remission of the acute episode. The results were compared with serum TNF levels in healthy controls and fresh pauci- and multibacillary leprosy patients.

Results: TNF levels in acute reactions were higher than in the control groups (significant only in upgrading reaction). In type 1 reaction, serum TNF concentrations fell to approximately the levels of the control patients following treatment and clinical remission. In type 2 reaction, however, levels of TNF were seen to rise further (became statistically significant) as a result of therapy induced clinical remission.

Conclusions: The rise in TNF-alpha level in reactions in leprosy is significant and indicates its active role in immunopathogenesis. The corresponding decline in TNF-alpha levels seen following regression of type 1 (lepra) reactions was not observed in the case of type 2 (ENL) reaction. This probably reflects the enhancement of cellular immunity in such cases and/or an attempt by the immunologic process to overcome specific inhibitors.

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Chloroquine / administration & dosage
  • Chloroquine / analogs & derivatives
  • Chloroquine / therapeutic use
  • Clofazimine / administration & dosage
  • Clofazimine / therapeutic use
  • Erythema Nodosum / blood*
  • Erythema Nodosum / drug therapy
  • Female
  • Humans
  • Hypersensitivity, Delayed / blood*
  • Hypersensitivity, Delayed / drug therapy
  • Leprostatic Agents / therapeutic use
  • Leprosy, Borderline / blood*
  • Leprosy, Borderline / drug therapy*
  • Leprosy, Lepromatous / blood*
  • Leprosy, Lepromatous / drug therapy*
  • Leprosy, Tuberculoid / blood*
  • Leprosy, Tuberculoid / drug therapy*
  • Male
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use
  • Tablets
  • Tumor Necrosis Factor-alpha / analysis*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Leprostatic Agents
  • Tablets
  • Tumor Necrosis Factor-alpha
  • chloroquine diphosphate
  • Chloroquine
  • Prednisolone
  • Clofazimine