Who treatment for ENL?

Erythema nodosum leprosum (ENL), also known as type II leprosy reaction, is a severe immune-mediated complication of multibacillary leprosy. For ENL, corticosteroids and thalidomide are the mainstays of treatment. Other immunosuppressants, such as clofazimine, cyclosporine, and azathioprine have also been used.

Why thalidomide is used in Lepra reaction?

Thalidomide is highly effective in the treatment of patients with chronic or recurrent ENL. It acts by inhibition of selective gene expression of tumour necrosis factor-α (TNF-α) involved in the pathogenesis of nerve damage in leprosy and other mechanisms contributing to its anti-inflammatory effect [13,14].

What is ENL disease?

Erythema nodosum leprosum (ENL), also known as lepra type 2 reaction, is a complication of lepromatous leprosy. It is characterized by the development of inflamed subcutaneous nodules accompanied at times by fever, lymphadenopathy, and arthralgias.

What is new in the pathogenesis and management of erythema nodosum Leprosum?

Erythema nodosum leprosum (ENL) is a manifestation of type II lepra reaction, seen in lepromatous or borderline lepromatous leprosy. Although it is a common reaction encountered in clinical practice, there are an increasingly large number of newer updates in the pathophysiology and management of this condition.

Is thalidomide used to treat leprosy?

Erythema nodosum leprosum (ENL) is a reactive state in lepromatous leprosy. Thalidomide has been used to treat ENL since the 1960s. One of its mechanisms of action is anti-inflammatory through selective inhibition of the pro-inflammatory cytokine TNF-alpha produced by monocytes.

Is thalidomide used in leprosy?

During the mid-1960s, the drug thalidomide was reintroduced as treatment for a complication of leprosy called Erythema nodosum leprosum (ENL). Although the evidence was not fully established, very soon the drug was heralded as the drug of choice for the management of ENL reactions in leprosy.

What is reversal reaction in leprosy?

Reversal reaction (or type 1 reaction) represents an increase in cellular immune response, with movement toward the tuberculoid pole of disease. This reaction is common in the borderline forms of leprosy and does not occur in the polar forms.

What drugs cause Lepra?

Prednisone at a dose of about 1 mg/kg/day, quickly tapered. Clofazimine (note that the multibacillary regimen with clofazimine prevents type 2 lepra reactions) Thalidomide 400 mg/day for 5–10 days, tapered over 1–2 months.

What causes erythema nodosum Leprosum?

Erythema Nodosum Leprosum (Lepra Type 2 Reactions) The pathogenesis of ENL is unclear, but it is believed to result from antigen-antibody complex deposition in the skin with the subsequent activation of complement. It is associated with high levels of TNF, which may decrease with treatment.

What is Lucio’s phenomenon?

Lucio phenomenon (LP) is a rare reactional state seen in cases of diffuse lepromatous leprosy. Lucio leprosy is a pure, primitive, and diffuse form of lepromatous leprosy. It is observed almost exclusively in Mexico and Central America and is considered a globally restricted phenomenon.