ERYTHEMA NODOSUM LEPROSUM
By Gary M. White, MD
Erythema nodosum leprosum (ENL) is an immune-mediated complication of leprosy in which immune complex deposition triggers a vasculitic process.
- ENL is characterized by recurrent painful nodules.
- It occurs in a background of borderline lepromatous or lepromatous leprosy.
- It is most common during the first 6 months of multi-drug therapy (MDT) therapy.
- Immune complex (bacillary antigen with immunoglobulins) formation and deposition triggers a vasculitis.
Prednisone is usually started initially at a dose of 40 mg/day or higher. Steroid-sparing agents that are often added include [JAMADerm 2015;151;1026]:
- Clofazimine 100 mg TID
- Pentoxifyllline 800 mg TID
- Colchicine 1.5 mg/day
- Azathioprine 100-150 mg/day
- Hydroxychloroqine 400 mg/day
- Minocycline 100 mg/day
Figure 1 of Actas Dermosifiliogr. 2013;104:915-9.
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