Table 1.
Salient changes in the recommendations by IADVL SIG Leprosy & IADVL academy between First recommendation[1] & the updated version
| First Recommendation[1] | Updated Recommendation | Level of Evidence |
|---|---|---|
| Advocacy (by IADVL & IADVL SIG Leprosy) | Continue | VII |
| Continuation of WHO MB MDT in event of likely COVID-19 infection | Recommendation unchanged (continue MDT) | VII |
| Provision of accompanied MDT whenever possible | Recommendation unchanged | VII |
| Continuation of leprosy-related services by state and district leprosy units | Recommendation unchanged | VII |
| Use of corticosteroids for reactions | Continue optimal dose of corticosteroids, exercising caution during phase of viremia. | II |
| Limit use of corticosteroids below 20 mg/day | ||
| Use of other immunosuppressants | Avoid, when possible, can be given if indicated under supervision. | V |
| Methotrexate (clinical trials ongoing for possible benefit in cytokine storm due to COVID-19) | ||
| Colchicine (clinical trials ongoing for possible benefit in COVID-19) | ||
| Use of chloroquine & hydroxychloroquine | Not recommended in view of recent evidence of their non-benefit vis-à-vis co-infection with COVID-19 | II |
| Use of alternate MDT in case of nonavailability of WHO MDT | Recommendation unchanged | VII |
| Emphasis on self-care for prevention of ulcers and deformities | Recommendation unchanged | VII |
| Use of teledermatology and telecounseling services | Recommendation unchanged. | VII |
| A hybrid model utilizing trained healthcare workers can be oriented for taking leprosy care directly to the patient. (see algorithm) | ||
| Use of minocycline | Recommendation unchanged | VII |
| Elective reconstructive surgeries to be rescheduled | Can be performed as per need under due COVID protocol | VII |
| Leprosy post exposure prophylaxis (LPEP) | LPEP to be offered to all close contacts wherever the index case and family members consent. | VII |
| Role of Clofazimine | Clofazimine, impressive in-vitro efficacy in COVID-19, can be tried in traditional dosages (open market availability is a limiting factor) | VII |
| COVID vaccination | To be encouraged, patients under steroids to be informed about possible sub-optimal uptake. | VII |
| MIP can be offered to patients who are not yet eligible as per national COVID vaccination guidelines. | ||
| Emerging cases of mucormycosis | Exercise extra caution while starting steroids and educate the patient regarding early signs (see Table 2) | VII |
| Hypercoagulability and thromboembolic events | In possibly thromboembolic conditions like leprosy patient with reaction on steroids with or without thalidomide. It is recommend to | VII |
| a. add acetyl salicylic acid (100 mg daily) and | ||
| b. avoid concomitant use of steroid with thalidomide | ||
| Mental health | Mental health is an important concern and should be specifically enquired about and offered appropriate counseling on a case-to-case basis. | VII |
IADVL: The Indian Association of Dermatologists, Venereologists and Leprologists; SID: Special Interest Group; WHO: World Health Organization; MDT: multidrug therapy; Covid 19: coronavirus disease