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Erythema nodosum leprosum (ENL) or type 2 lepra reactions complicate lepromatous leprosy and borderline lepromatous leprosy. We report an 11-year retrospective case record analysis of 481 outpatients with borderline lepromatous and lepromatous leprosy at the Dhoolpet Leprosy Research Center in Hyderabad, India.. The overall prevalence of ENL was 24%, 49.4% among cases of lepromatous leprosy (LL) and 9% among cases of borderline lepromatous (BL) leprosy. Logistic regression analysis identified LL (odds ratio [OR] = 8.4, 95% confidence interval [CI] = 4.6–15.4, P < 0.001) and BL with a bacterial index 
4+ (OR = 5.2, 95% CI = 2.1–12.9, P = 0.001) as major risk factors. The average patient with ENL was male, 34.7 years of age, and had multiple episodes of ENL (mean = 3.1) over an 18.5-month period. Three types of ENL were identified: single acute ENL, multiple acute ENL (repeated discrete episodes), and chronic ENL (continuous episodes). Acute single ENL is rare, accounting for only 8% of cases. Chronic ENL accounted for 62.5% of the cohort. Chronic ENL was of longer duration and more severe. An age 35 years was a risk factor for developing chronic ENL. Patients with chronic ENL were more compliant with multi-drug therapy, especially during the first six doses of multi-drug therapy. Distinguishing these different types of ENL would be useful for patient management and developing improved treatment of these debilitating reactions. Improved strategies for treatment and management of these reactions need to be developed.
Received August 10, 2005. Accepted for publication November 22, 2005.
Acknowledgments: We thank BPRC for making their facilities available for this project. The project was initiated and designed by Diana N. J. Lockwood with help from Leonor Pocaterra, Suman Jain, and Sujai Suneetha. Patient data was collected by Suman Jain, Syed Muzaffarullah, and Leonor Pocaterra. Data analysis and write up was done by Leonor Pocaterra and Diana N. J. Lockwood. Diana N. J. Lockwood is the guarantor for this report.
Financial support: The Blue Peter Research Centre and the Dhoolpet Leprosy Research Centre are run and managed by Lepra-India, which is supported by Lepra UK. Additional support is received from the Medical Research Council, UK through Lepra UK. Leonor Pocaterra received a student travel award from the London School of Hygiene and Tropical Medicine student bursary scheme.
Disclosure: Diana N. J. Lockwood was a paid adviser to Pharmion during their application to the European Medicines Agency to have thalidomide licensed for use in the treatment of ENL.
* Address correspondence to Diana N. J. Lockwood, Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: diana.lockwood{at}lshtm.ac.uk
Authors’ addresses: Leonor Pocaterra, Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom and Cátedra de Parasitología, Escuela de Medicina JM Vargas, Universidad Central de Venezuela, Caracas, Venezuela. Suman Jain, Rajgopal Reddy, Syed Muzaffarullah, Obdulita Torres, and Sujai Suneetha, Blue Peter Research Centre, Cherlapally, Hyderabad 501 301, AP, India. Diana N. J. Lockwood, Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, E-mail: diana.lockwood{at}lshtm.ac.uk.
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  S. L. Walker and D. N. J. Lockwood The clinical and immunological features of leprosy Br. Med. Bull., November 7, 2006; (2006) ldl010v1. [Abstract] [Full Text] [PDF]
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