Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 9;14(10):e0008678.
doi: 10.1371/journal.pntd.0008678. eCollection 2020 Oct.

Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: A five-year retrospective analysis from a leprosy referral centre in India

Brahmaiah Upputuri  1 , Michael Sukumar Pallapati  1 , Patrick Tarwater  2 , Aparna Srikantam  3
Affiliations

Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: A five-year retrospective analysis from a leprosy referral centre in India

Brahmaiah Upputuri et al. PLoS Negl Trop Dis. .

Abstract

Erythema nodosum leprosum (ENL), or type 2 lepra reaction, is a multi-system immune-mediated complication in patients with multibacillary leprosy, frequently associated with chronicity and recurrences. Management of ENL requires high doses of oral corticosteroids, which may not be universally effective and pose serious adverse effects. Thalidomide has proven to be a steroid-sparing agent and is useful in controlling the reactions. However, many centres do not employ it in outpatient settings due to adverse effects and teratogenicity risk. Hence, we studied the feasibility of treating ENLs and reported the therapeutic outcome.This is a five-year record-based analysis of ENL leprosy patients treated with thalidomide, includingdescriptive statistics of demographic variables. Clinical characteristics were stratified by treatment compliance status (yes/no). Incidence rates and rate ratios for recovery stratified by bacillary index, type of ENL presentation and MDT treatment status were calculated.Out of 102 ENL patients treated with thalidomide, 68 (66.7%) were compliant and improved. Among them, ENL recurrence was noted in 11(16.2%) patients. The commonest thalidomide side effect was pedal oedema (73.5%). Patients with bacillary index (BI) less than or equal to 4.0 had a 37% increase in the incidence of recovery. Patients with acute ENL were almost twice as likely to recover as those with chronic ENL. Also, the improvement was two and a half times greater among those who completed MDT as compared to those on MDT. The study showed that thalidomide treatment for patients with ENL is possible in outpatientclinics. We also successfully prevented pregnancies to a larger extent through counselling for contraception.We observed that early institution of thalidomide induces faster remission and prevents ENL recurrence.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Side effects observed during thalidomide treatment.
Fig 2
Fig 2. Timing of initial side effects during treatment.
Fig 3
Fig 3
Clinical images of patient with ENL before (A) and after (B) thalidomide treatment.
Fig 4
Fig 4
Clinical images of patient with ENL before (A) and after (B) thalidomide treatment.
See this image and copyright information in PMC

References

    1. Singal A. Leprosy in post-elimination era in India: Difficult journey ahead. Indian journal of dermatology. 2013;58(6):443–446. 10.4103/0019-5154.119952 - DOI - PMC - PubMed
    1. Lockwood DNJ. Leprosy In: Burns DA, Breathnach S.M., Cox N.H.,Griffiths C.E.M.,editor. Rook’s Textbook of Dermatology 7th edOxford: Blackwell Publishing; pp. 2004; 2921–29.21.
    1. Walker SL, Lebas E, Doni SN, Lockwood DNJ, Lambert SM.The Mortality Associated with Erythema Nodosum Leprosum in Ethiopia: A Retrospective Hospital-Based Study. PLoSNegl Trop Dis.2014; 8(3): e2690. - PMC - PubMed
    1. Walker SL, Lockwood DN. Leprosy type 1 (reversal) reactions and their management. Lepr Rev. 2008; 79: 372–386. - PubMed
    1. Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, et al. Clinical course of erythema nodosum leprosum: An 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg. 2006;74:868–79. - PubMed

Publication types