• Stephen L Walker, Marivic Balagon, Joydeepa Darlong, Shimelis N Doni, Deanna A Hagge, Vikas Halwai, Annamma John, Saba M Lambert, Armi Maghanoy, Jose A C Nery, Kapil D Neupane, Peter G Nicholls, Vivek V Pai, Pawan Parajuli, Anna M Sales, Euzenir Sarno, Mahesh Shah, Digafe Tsegaye, Diana N J Lockwood, and Erythema Nodosum Leprosum International STudy Group.
• Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
• PLoS Negl Trop Dis. 2015 Jan 1; 9 (9): e0004065.

AbstractErythema 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. 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.

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