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Interventions for erythema nodosum leprosum

  1. Natasja HJ Van Veen1,*,
  2. Diana NJ Lockwood2,
  3. Wim H van Brakel3,
  4. Jose Ramirez Jr4,
  5. Jan Hendrik Richardus1

Editorial Group: Cochrane Skin Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 10 MAR 2009

DOI: 10.1002/14651858.CD006949.pub2

Database Title

Additional Information

How to Cite

Van Veen NHJ, Lockwood DNJ, van Brakel WH, Ramirez Jr J, Richardus JH. Interventions for erythema nodosum leprosum. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006949. DOI: 10.1002/14651858.CD006949.pub2.

Author Information

  1. 1

    Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands

  2. 2

    London School of Hygiene & Tropical Medicine, Department of Infectious Diseases, London, UK

  3. 3

    Royal Tropical Institute, Leprosy Unit, Amsterdam, Netherlands

  4. 4

    University of Nottingham, c/o Cochrane Skin Group, Nottingham, UK

*Natasja HJ Van Veen, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, Netherlands. n.vanveen@erasmusmc.nl.

Publication History

  1. Publication Status: New
  2. Published Online: 8 JUL 2009

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Arora 1985 {published data only}
  • Arora SK, Singh G, Sen PC. Levamisole in cases of E.N.L. Indian Journal of Leprosy 1985;57(1):17-21.
Girdhar 2002 {published data only}
  • Girdhar A, Chakma JK, Girdhar BK. Pulsed corticosteroid therapy in patients with chronic recurrent ENL: a pilot study. Indian Journal of Leprosy 2002;74(3):233-6.
Helmy 1971 {published data only}
  • Helmy HS, Pearson JM, Waters MF. Treatment of moderately severe erythema nodosum leprosum with clofazimine--a controlled trial. Leprosy Review 1971;42(3):167-77.
Ing 1969 {published data only}
  • Ing TH. Indomethacin in the treatment of erythema nodosum leprosum, in comparison with prednisolone. Singapore Medical Journal 1969;10(1):66-70.
Iyer 1971 {published data only}
  • Iyer CG, Languillon J, Ramanujam K, Tarabini-Castellani G, De las Aguas JT, Bechelli LM, et al. WHO co-ordinated short-term double-blind trial with thalidomide in the treatment of acute lepra reactions in male lepromatous patients. Bulletin of the World Health Organization 1971;45(6):719-32.
Iyer 1976 {published data only}
  • Iyer CG, Ramu G. An open trial with clofazimine in the management of recurrent lepra reaction using thalidomide as a control drug. Lepra in India 1976;48(4 Suppl):690-4.
Karat 1969 {published data only}
  • Karat AB, Thomas G, Rao PS. Indomethacin in the management of erythema nodosum leprosum--a double-blind controlled trial. Leprosy Review 1969;40(3):153-8.
Karat 1970 {published data only}
Pearson 1969 {published data only}
  • Pearson JM, Vedagiri M. Treatment of moderately severe erythema nodosum leprosum with thalidomide - a double-blind controlled trial. Leprosy Review 1969;40(2):111-6.
Sales 2007 {published data only}
  • Sales AM, de Matos HJ, Nery JA, Duppre NC, Sampaio EP, Sarno EN. Double-blind trial of the efficacy of pentoxifylline vs thalidomide for the treatment of type II reaction in leprosy. Brazilian Journal of Medical and Biological Research = Revista brasileira de pesquisas médicas e biológicas / Sociedade Brasileira de Biofísica ... [et al.] 2007;40(2):243-8.
Sheskin 1969 {published data only}
  • Sheskin J, Convit J. Results of a double-blind study of the influence of thalidomide on the lepra reaction. International Journal of Leprosy & Other Mycobacterial Diseases 1969;37(2):135-46.
Villahermosa 2005 {published data only}
  • Villahermosa LG, Fajardo TT, Abalos RM, Balagon MV, Tan EV, Cellona RV, et al. A randomized, double-blind, double-dummy, controlled dose comparison of thalidomide for treatment of erythema nodosum leprosum. The American Journal of Tropical Medicine and Hygiene 2005;72(5):518-26.
Waters 1971 {published data only}
  • Waters MF. An internally-controlled double blind trial of thalidomide in severe erythema nodosum leprosum. Leprosy Review 1971;42(1):26-42.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Anonymous 1976 {published data only}
  • Anonymous. Spaced clofazimine therapy of lepromatous leprosy. The American Journal of Tropical Medicine and Hygiene 1976;25(3):437-44.
Arruda 1986 {published data only}
  • Arruda WO, Hacbarth E, Döi E, Santa-Maria JR, Barbosa J, Kajdacsy-Balla AA. Effect of thalidomide on serum levels of immunoglobulins IgM and IgA, rheumatoid factor and isohemagglutinins anti-A and anti-B in patients with lepromatous leprosy. A double-blind study [Efeito da talidomida sobre os niveis séricos de imunoglobulinas IgM e IgA, fator rheumatöide e isohemaglutinina anti-A e anti-B em pacientes com lepra lepromatosa. Um estudo duplo-cego]. Revista do Instituto de Medicina Tropical de São Paulo 1986;28(1):12-4.
Browne 1981 {published data only}
  • Browne SG, Harman DJ, Waudby H, McDougall AC. Clofazimine (Lamprene, B663) in the treatment of lepromatous leprosy in the United Kingdom. A 12 year review of 31 cases, 1966-1978. International Journal of Leprosy & Other Mycobacterial Diseases 1981;49(2):167-76.
Dawlah 2002 {published data only}
  • Dawlah ZM, Cabrera A, Ahern K, Levis WR. A phase 2 open trial of pentoxifylline for the treatment of leprosy reactions. International Journal of Leprosy & Other Mycobacterial Diseases 2002;70(1):38-43.
de Almeida Neto 1981 {published data only}
  • de Almeida Neto E. Comparative study of the therapeutic activity of glutamic acid phthalimide and the therapeutic activity of triamcinolone in the treatment of Hansen's reaction of Virchowian Leprosy [Estudo comparativo entre a atividade terapeutica da imidaftalica do acido glutamico e a atividade terapeutica da triancinolona no tratamento da reacao hansenica da hanseniase Virchowiana]. Hansenologia Internationalis 1981;6(2):114-21.
de Carsalade 2003 {published data only}
  • de Carsalade GY, Achirafi A, Flageul B. Pentoxifylline in the treatment of erythema nodosum leprosum: results of an open study [Efficacite de la pentoxifylline dans le traitement de l'erytheme noueux lepreux: resultats d'une etude ouverte]. Acta Leprologica 2003;12(3):117-22.
  • De Carsalade GY, Achirafi A, Flageul B. Pentoxifylline in the treatment of erythema nodosum leprosum. Journal of Dermatology 2003;30(1):64-8.
Garbino 2006 {published data only}
  • Garbino JA. Clinical and neurophysiologic randomized trial about ulnar neuropathy responses, in type 1 and type 2 Hansen's disease reactions under oral steroid treatment [Ensaio clinico e neurofisiologico sobre a resposta do nervo ulnar, na hanseniase em reacao tipo 1 e tipo 2, sob differentes regimes de esteroides via oral]. Thesis 2006.
Hastings 1970 {published data only}
  • Hastings RC, Trautman JR, Enna CD, Jacobson RR. Thalidomide in the treatment of erythema nodosum leprosum. With a note on selected laboratory abnormalities in erythema nodosum leprosum. Clinical Pharmacology and Therapeutics 1970;11(4):481-7.
Huang 1987 {published data only}
  • Huang RX, Lu LN, Shao KW. Treatment of type II lepra reaction with Tripterygium Wilfordii Hook F(leigongteng) and thalidomide (Chinese). Journal of Chinese leprosy 1987;3(3):163-4.
Imkamp 1968 {published data only}
  • Imkamp FM. A treatment of corticosteroid-dependent lepromatous patients in persistent erythema nodosum leprosum. A clinical evaluation of G.30320 (B663). Leprosy Review 1968;39(3):119-25.
Imkamp 1973 {published data only}
  • Imkamp FM. The treatment of corticosteroid-dependent lepromatous patients in persistent Erythema nodosum leprosum with clofazimine. Leprosy Review 1973;44(3):127-30.
Jamet 1992 {published data only}
  • Jamet P, Traore I, Husser JA, Ji B. Short-term trial of clofazimine in previously untreated lepromatous leprosy. International Journal of Leprosy & Other Mycobacterial Diseases 1992;60(4):542-8.
Kar 1988 {published data only}
Karat 1971a {published data only}
Karat 1971b {published data only}
  • Karat AB, Jeevaratnam A, Karat S, Rao PS. Efficacy of clofazimine in the prophylaxis and suppression of reactive phases of lepromatous leprosy. International Journal of Leprosy & Other Mycobacterial Diseases 1971;39(4):838-41.
Levy 1973 {published data only}
Manungo 1982a {published data only}
  • Manungo J, Thomas JE. A comparison of the incidence of type 2 reactions in lepromatous leprosy with two regimens of treatment. Central African Journal of Medicine 1982;28(9):209-11.
Manungo 1982b {published data only}
Moreira 1998 {published data only}
  • Moreira AL, Kaplan G, Villahermosa LG, Fajardo TJ, Abalos RM, Cellona RV, et al. Comparison of pentoxifylline, thalidomide and prednisone in the treatment of ENL. International Journal of Leprosy & Other Mycobacterial Diseases 1998;66(1):61-5.
Partida-Sanchez 1998 {published data only}
  • Partida-Sanchez S, Favila-Castillo L, Pedraza-Sanchez S, Gomez-Melgar M, Saul A, Estrada-Parra S, et al. IgG antibody subclasses, tumor necrosis factor and IFN-gamma levels in patients with type II lepra reaction on thalidomide treatment. International Archives of Allergy and Immunology 1998;116(1):60-6.
Penna 2005 {published data only}
  • Penna GO, Macedo VO, Martelli CMT, Maroja MDF, Stefani MMA, Chaul A. Thalidomide in the treatment of erythema nodosum leprosum (ENL): Systematic review of clinical trials and prospects of new investigations. Anais Brasileiros de Dermatologia 2005;80(5):511-522.
Pettit 1967 {published data only}
  • Pettit JH. The treatment of erythema nodosum leprosum with B.663. A controlled study. International Journal of Leprosy & Other Mycobacterial Diseases 1967;35(1):11-6.
Plock 1976 {published data only}
  • Plock H, Leiker DL. A long term trial with clofazimine in reactive lepromatous leprosy. Leprosy Review 1976;47(1):25-34.
Ramu 1979 {published data only}
  • Ramu G, Girdhar A. Treatment of steroid dependant cases of recurrent lepra reaction with a combination of thalidomide and clofazimine. Leprosy in India 1979;51(4):497-504.
Rodriguez 1974 {published data only}
  • Rodriguez JN, Abalos RM, Reich CV, Tolentino JG. Effects of the administration of B663 [G 30 320, Lamprene, clofazimine (Geigy)] on three groups of lepromatous and borderline of leprosy. International Journal of Leprosy & Other Mycobacterial Diseases 1974;42(3):276-88.
Sharma 1982 {published data only}
  • Sharma VK, Saha K, Sehgal VN. Serum immunoglobulins an autoantibodies during and after erythema nodosum leprosum (ENL). International Journal of Leprosy & Other Mycobacterial Diseases 1982;50(2):159-63.
Sharma 1986 {published data only}
  • Sharma VK, Kumar B, Kaur I, Singh M, Kaur S. Colchicine in the treatment of type 2 lepra reaction. Indian Journal of Leprosy 1986;58(1):43-7.
Sheskin 1969a {published data only}
  • Sheskin J, Magora A, Sagher F. Motor conduction velocity studies in patients with leprosy reaction treated with thalidomide and other drugs. International Journal of Leprosy and Other Mycobacterial Diseases 1969;37(4):359-64.
Sheskin 1971 {published data only}
  • Sheskin J, Sagher F. Five years' experience with thalidomide treatment in leprosy reaction. International Journal of Leprosy and Other Mycobacterial Diseases 1971;39(2):585-8.
Sheskin 1983 {published data only}
Sunderkotter 2005 {published data only}
  • Sunderkotter CH, Lan Ma H. Clofazimine. Current status of therapy with clofazimine (Lampren) for leprosy, erythema leprosum, and other dermatoses after donation of the medicine to the WHO by Novartis. Hautarzt 2005;56(5):478-9.
Vides 1999 {published data only}
  • Vides EA, Cabrera A, Ahern KP, Levis WR. Effect of zafirlukast on leprosy reactions. International Journal of Leprosy and Other Mycobacterial Diseases 1999;67(1):71-5.
Zaheer 1993 {published data only}
  • Zaheer SA, Misra RS, Sharma AK, Beena KR, Kar HK, Mukherjee A, et al. Immunotherapy with Mycobacterium w vaccine decreases the incidence and severity of type 2 (ENL) reactions. Leprosy Review 1993;64(1):7-14.
Zhang 2008 {published data only}
  • Zhang Z. Therapeutic effect observation of ENL reaction treated with combination of traditional Chinese and Western medicine. Abstracts of the 17th International Leprosy Congress Hyderabad, India. 2008.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Salim 2009 {published data only}
  • Salim AH. Montelukast in ENL reaction. Available from http://clinicaltrials.gov/show/NCT00406861.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Barton 1974
Faber 2006
Hastings 1988
  • Hastings RC, Gillis TP, Krahenbuhl JL, Franzblau SG. Leprosy. Clinical Microbiology Reviews 1988;1(3):330-48.
Heijnders 2004
Higgins 2008
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1 [updated September 2008]. The Cochrane Collaboration. Available from www.cochrane-handbook.org, 2008.
ILEP 1996
  • The International Federation of Anti-Leprosy Associations (ILEP). The management of erythema nodosum leprosum. ILEP Technical Bulletin 1996, issue 9.
ILEP 2001
  • The International Federation of Anti-Leprosy Associations (ILEP). How to diagnose and treat leprosy. London: ILEP, 2001.
ILEP 2002
  • The International Federation of Anti-Leprosy Associations (ILEP). How to recognise and manage reactions. London: ILEP, 2002.
Job 2008
  • Job CK, Jayakumar J, Kearney M, Gillis TP. Transmission of leprosy: a study of skin and nasal secretions of household contacts of leprosy patients using PCR. American Journal of Tropical Medicine and Hygiene 2008;78(3):518-21.
Juni 2001
Kahawita 2008
Kumar 2004
  • Kumar B, Dogra S, Kaur I. Epidemiological characteristics of leprosy reactions: 15 years experience from north India. International Journal of Leprosy and Other Mycobacterial Diseases 2004;72(2):125-33.
Lockwood 1996
Lockwood 2007
Mahajan 1994
  • Mahajan PM, Jadhav VH, Patki AH, Jogaikar DG, Mehta JM. Oral zinc therapy in recurrent erythema nodosum leprosum: a clinical study. Indian Journal of Leprosy 1994;66(1):51-7.
Manandhar 1999
  • Manandhar R, LeMaster JW, Roche PW. Risk factors for erythema nodosum leprosum. International Journal of Leprosy and Other Mycobacterial Diseases 1999;67(3):270-8.
Naafs 2003a
  • Naafs B. Reactions: the body as battlefield I: clinical aspects. Memisa Medisch 2003;69(2):330-6.
Naafs 2003b
  • Naafs B. Reactions: the body as battlefield II: immunopathology. Memisa Medisch 2003;69(2):337-42.
Nery 1998
  • Nery JA, Vieira LM, de Matos HJ, Gallo ME, Sarno EN. Reactional states in multibacillary Hansen disease patients during multidrug therapy. Revista do Instituto de Medicina Tropical de São Paulo 1998;40(6):363-70.
Nery 2000
  • Nery JA, Perisse AR, Sales AM, Vieira LM, Souza RV, Sampaio EP, et al. The use of pentoxifylline in the treatment of type 2 reactional episodes in leprosy. Indian Journal of Leprosy 2000;72(4):457-67.
Pedley 1976
  • Pedly JC, Geater JG. Does droplet infection play a role in the transmission of leprosy?. Leprosy Review 1976;47(2):97-102.
Pocaterra 2006
  • Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, et al. Clinical course of erythema nodosum leprosum: an 11-year cohort study in Hyderabad, India. American Journal of Tropical Medicine and Hygiene 2006;74(5):868-79.
Rafferty 2005
Ridley 1966
  • Ridley DS, Jopling WH. Classification of leprosy according to immunity. A five-group system. International Journal of Leprosy and Other Mycobacterial Diseases 1966;34(3):255-73.
Saunderson 2000
  • Saunderson P, Gebre S, Byass P. ENL reactions in the multibacillary cases of the AMFES cohort in central Ethiopia: incidence and risk factors. Leprosy Review 2000;71(3):318-24.
Smith 2002
  • Smith WC, Nicholls PG. Special workshop on repeated and late reactions. International Journal of Leprosy and Other Mycobacterial Diseases 2002;70(4):339-41.
Uyemura 1986
Van Brakel 2005
  • van Brakel WH, Nicholls PG, Das L, Barkataki P, Suneetha SK, Jadhav RS, et al. The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India. Leprosy Review 2005;76(1):277-95.
Walker 2007
WHO
  • World Health Organization. WHO Guidelines for the management of severe erythema nodosum leprosum (ENL) reactions. Available from http://www.who.int/lep/research/WHOenlguide.pdf (Accessed 4 August 2008).
WHO 1998
WHO 2000
  • World Health Organization. Guide to Eliminate Leprosy as a Public Health Problem. Geneva: World Health Organization, 2000.
WHO 2003
  • World Health Organization. The Final Push Strategy to Eliminate Leprosy as a Public Health Problem. Questions and Answers. Geneva: World Health Organization, 2003.
WHO 2006
  • World Health Organization. Leprosy. Available from http://www.who.int/mediacentre/factsheets/fs101/en/index.html (Accessed 27 November 2006).
WHO 2008
Zaheer 1993
  • Zaheer SA, Misra RS, Sharma AK, Beena KR, Kar HK, Mukherjee A, et al. Immunotherapy with Mycobacterium w vaccine decreases the incidence and severity of type 2 (ENL) reactions. Leprosy Review 1993;64(1):7-14.
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