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.
BT - Anais Brasileiros de Dermatologia CN - GUERRA 2002 CY - Rio de Janeiro IS - 4 LA - por N2 -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.
PP - Rio de Janeiro PY - 2002 SP - 389 EP - 407 T2 - Anais Brasileiros de Dermatologia TI - [Erythema Nodosum Leprosum: clinical and therapeutic up-date] TT - Eritema nodoso hansenico: atualizacao clinica e terapeutica VL - 77 ER -