01768nas a2200181   4500000000100000008004100001260001900042653001200061100001100073700001800084700002300102700002100125245006600146300001300212490000700225050001600232520133800248       2002                            d  aRio de Janeiro10aleprosy1 aPenna 1 aGomes Guerra 1 aMiranda de Castro 1 aTurchi Martelli 00a[Erythema Nodosum Leprosum: clinical and therapeutic up-date]  a389-407 0 v77  aGUERRA 20023 a<p>Erythema Nodosum Leprosum (ENL) is a syndrome that occurs before, during or after leprosy treatment, often interrupting the chronic course of M. leprae infection. ENL is considered an important cause of morbidity among lepromatous patients, which may lead to nerve injury, paralysis and deformity without prompt medical care. Nowadays, ENL episodes are considered one of the main causes of hospitalization among lepromatous patients in many endemic Brazilian regions. This paper reviews the epidemiological data on ENL according to different settings. The histopathological pattern and a concise description of the immunologic mechanism underlying type 2 reactions are presented. A semi-objective clinical criterion for grading ENL severity, applicable under field conditions, is proposed. Thalidomide is considered the drug of choice for ENL treatment according to the official Leprosy Control Program. Systemic steroid is mandatory for the treatment of peripheral neuritis, iritis and orchitis associated with ENL. This paper points out the lack of reliable data on reactive episodes and the widespread and possible abuse of steroid therapy on a routine basis. An effective surveillance system including pharmacovigilance is needed for detecting steroid-associated adverse events in this novel leprosy elimination context.</p>