Leprosy Mailing List – October 20 , 2013
Ref.: (LML) MB patients without clear treatment status and chronic ENL
From: Wim van Brakel, Amsterdam, the Netherlands
Dear Pieter,
Thanks for the interesting question raised by Dr. José Augusto in LML of October 20, 2013.
The difficulty seems to be the reliability of the history of treatment. I'm inclined to trust (former) patients regarding what they tell me. It may take time though to win their trust and to explain that you need this information to decide on the best course of treatment for them. If there is doubt, I would give another course of MB MDT. This is particularly useful if patients will remain under your or someone else's medical supervision during that time.
In my view it is not useful to restart MDT in the case of post-MDT ENL reactions, if a full course of MDT has been completed. The reason that the incidence of ENL reactions increases after release from MDT is the loss of the anti-inflammatory effect of clofazimine. A reaction is not a sign of bacterial activity, as I'm sure you know, at least not in the first few years after MDT.
Clofazimine has a definite role in post-MDT ENL reaction management, particularly in patients with repeated episodes of reaction. Thalidomide is very effective, but not necessary unless reactions are very severe or insufficiently treated with clofazimine and corticosteroids.
With kind regards,
Wim van Brakel, MD MSc PhD
Technical Advisor NLR
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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