Clofazimine and erythema nodosum leprosum (ENL or type 2) reaction

Leprosy Mailing List – September 28^th, 2010

Ref.:   Clofazimine and erythema nodosum leprosum (ENL or type 2) reaction.

From: H K Kar, New Delhi, India

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Dear Dr Maria Leide,

Thank you very much for your message dated LML Sept. 25^th, 2010.  I agree with you fully regarding possibility of development of resistance due to use of clofazimine alone for management of late type 2 reaction after multi-drug therapy (MDT).  We are all aware of the fact that high bacteriological index (BI) is associated with relapse as well as late recurrent ENL reaction in lepromatous (LL) patients. The 12 MONTHS MDT for multibacillary (MB) patients may not be sufficient to kill all live bacilli, particularly with higher BI, more than 4+.  There is always chance of relapse in those cases with clofazimine resistant bacilli.  Therefore, in those cases it is ideal to  continue MDT-MB along with higher dose of clofazimine for treatment of ENL.

Regards,

Dr (Prof.) H K Kar
Consultant & HOD
Department of Dermatology, STD & Leprosy
P.G.I.M.E.R. and Dr Ram Manohar Lohia Hospital
Baba Kharag Singh Marg
New Delhi-110001

India