Topical 1% propranolol in liposomal gel: A new adjuvant tool for chronic leprosy ulcers

Objective: To evaluate the effects of 1% topical propranolol in liposomal gel in 3 patients with plantar ulcers. Methods: We enrolled 3 patients with 3 ulcers who had completed the WHO recommended treatment regimen. The ulcers were cleaned with sterile normal saline, and 1% topical propranolol in liposomal gel was applied 2 times/day for 3 months, or less if complete healing was reached before. Assessment of ulcer re-epithelization was recorded at baseline, 6 weeks, and 3 and 6 months after initiation of treatment. Results: Response in the form of granulation tissue formation started by the second week. Substantial reduction in size subsequently continued over the next 3 months. Two of the 3 patients showed complete healing of the ulcers at the 6 months follow up. In the 3rd patient, the ulcer showed only modest signs of healing. Surprisingly, in all patients, the sensory function was restored, particularly in terms of pain. Some motor functional recovery at the ulcer site and surrounding tissue was also documented. Conclusion: To the best of our knowledge, this is the first trial of topical propranolol for the treatment of trophic ulcers of leprosy. This may represent a promising adjuvant therapy for leprosy ulcers, including ulcers of older age. Further studies are warranted with a larger number of patients and a longer period of follow up to determine the ideal candidates and to identify clinical factors predictive of response.