02734nas a2200145   4500000000100000008004100001100001300042700001200055700001200067245012500079856008700204300001200291490000700303520227800310       2021                            d1 aSingla P1 aJoshi R1 aShah BJ00aThalidomide in Severe Erythema Nodosum Leprosum (ENL) - Our Experience in Chronic, Recurrent and Steroid-Dependant Cases  uhttp://www.ijl.org.in/2021-apr-jun/1-%20P%20Singla%20et%20al%20(115-128)%20(1).pdf  a115-1280 v933 aIn India, Leprosy is still an important health problem. In the Indian context, there are about 15-20% of leprosy
patients come with erythema nodosum leprosum (ENL) as their first presentation. Due to its prolonged
course, ENL has a detrimental impact on quality of life (QoL) and is the commonest reason for admission to the
hospital. Apart from physical disabilities, ENL causes financial problems for patients and their families as
young patients are more often affected, leading to their inability to work and loss of jobs. Early diagnosis and
prompt treatment can reduce disability and deformity. Among the various treatment modalities available,
steroids and thalidomide are the most effective drugs for ENL. The aim of this research work was to study the
demographic and clinical profile of ENL patients with the objective to evaluate the therapeutic response and
recurrence rate observed in ENL patients treated with steroids or thalidomide; and to assess the role of
thalidomide in chronic, recurrent and steroid-dependent cases of ENL. A longitudinal observational study was
carried out at Civil Hospital Ahmedabad from June 2016 to May 2019, comprising type 2 reaction patients. Of
467 total leprosy patients treated during this period, 224 (48%) had either type 1(90) or type 2 (134) lepra
reactions. Patients with mild to moderate ENL were given tablet prednisolone 1mg/kg/d followed by tapering
by 5mg every two weeks while patients with severe, chronic, recurrent and steroid-dependent ENL were
started on thalidomide 400mg followed by tapering by 100mg every four weeks along with prednisolone with
st the same dose as above. Out of 134 ENL patients, 57 (42.5%) presented with type 2 reaction at 1 visit before
starting multi-drug therapy (MDT), 54 (40.2%) after initiation of MDT while 23 (17.1%) after MDT completion.
Among 82 patients on prednisolone, 12 (14.6%) patients had recurrence at two months, 18 (22%) at three
months, 8 (9.7%) at six months and 5(6.1%) after six months of treatment. Among 52 patients with severe ENL
on thalidomide, 5 (9.6%) patients had recurrence at two months, 2 (3.8%) at six months of treatment.
Thalidomide decreases the recurrence rate with steroid dependency and helps to limit steroid side effects.