Erythema Nodosum Leprosum (ENL) treated with additional Clofazimine – A case series

Erythema Nodosum Leprosum (ENL) reaction is a complication of smear-positive multibacillary leprosy (MB) and often results in pain, disability and a reduction in quality of life. A large proportion (30%) of MB smear positive cases suffer from ENL at some point of time.

Corticosteroids for treating chronic/recurrent ENL have many adverse effects and there is no evidence that prophylactic steroids prevent the onset of the first episode of ENL. Clofazimine (in doses of 100 mg/day or more) has long been used to reduce the severity and recurrence of ENL. There is limited published evidence for its effectiveness, though its effectiveness is known.

We present here four cases who were treated with the regimen comprising the standard WHO recommended regimen of Prednisolone plus High Dose Clofazimine (HDC) for 6 to 12 months. All four cases completed 12 months from initiation of the high dose Clofazimine plus Prednisolone regimen, ENL had resolved well and there was no deterioration of NFI. There were no further episodes of ENL reaction and none had any serious adverse effects up to 12 months and they are continuing under surveillance for another 12 months. All four cases were assessed for health-related quality of life using the SF-36 questionnaire, showing improvement as compared to the baseline.

These preliminary observations of not only resolution of ENL reaction, but also improving the quality of life, instills confidence in the regimen and confirms the need and feasibility of undertaking a larger randomised controlled trial with adequate sample size.