02547nas a2200361   4500000000100000008004100001100001400042700001400056700001400070700001100084700001200095700001300107700001100120700001400131700001600145700001200161700001500173700001600188700001000204700001500214700001200229700001200241700001100253700001400264700001600278700005800294245012100352856007900473300001300552490000600565520160000571022001402171       2015                            d1 aWalker SL1 aBalagon M1 aDarlong J1 aDoni S1 aHagge D1 aHalwai V1 aJohn A1 aLambert S1 aMaghanoy AA1 aNery JA1 aNeupane KD1 aNicholls PG1 aPai V1 aParajuli P1 aSales A1 aSarno E1 aShah M1 aTsegaye D1 aLockwood DN1 aErythema Nodosum Leprosum International  Study Group 00aENLIST 1: An international multi-centre cross-sectional study of the clinical features of erythema nodosum leprosum.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004065   ae00040650 v93 a<p>Erythema nodosum leprosum (ENL) is a severe multisystem immune mediated complication of borderline lepromatous leprosy and lepromatous leprosy. ENL is associated with skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. The treatment of ENL requires immunosuppression, which is often required for prolonged periods of time and may lead to serious adverse effects. ENL and its treatment is associated with increased mortality and economic hardship. Improved, evidence-based treatments for ENL are needed; however, defining the severity of ENL and outcome measures for treatment studies is difficult because of the multiple organ systems involved.</p>

<p>A cross-sectional study was performed, by the members of the Erythema Nodosum Leprosum International STudy (ENLIST) Group, of patients with ENL attending seven leprosy referral centres in Brazil, Ethiopia, India, Nepal, the Philippines and the United Kingdom. We systematically documented the clinical features and type of ENL, its severity and the drugs used to treat it. Patients with chronic ENL were more likely to be assessed as having severe ENL. Pain, the most frequent symptom, assessed using a semi-quantitative scale was significantly worse in individuals with "severe" ENL. Our findings will determine the items to be included in a severity scale of ENL which we are developing and validating. The study also provides data on the clinical features of ENL, which can be incorporated into a definition of ENL and used for outcome measures in treatment studies.</p>
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