Leprosy Mailing List – July 1, 2015
Ref.: (LML) Bolus treatment and the prevention of nerve damage in Erythema Nodosum Leprosum ENL
From: Arry Pongtiku, Irian Jaya, Indonesia
Dear Pieter,
Good morning.
Thank you very much for this topic, and thank you the email of Geeske Zijp (LML, 30-06-2015). As I worked as a leprosy doctor, I would like to share my experience of ENL reaction. I once talked to a senior dermatologist in Indonesia (dr Emmy Syamsoe,SpK(K) that "there were some medical doctors not treat leprosy very well, still underestimating leprosy". Dr Emmy answered they will understand if they treat leprosy reaction and steroid dependency, even dermatologists will face some difficulties. You are not alone found like this.
The very important things to treat leprosy reaction (ENL) we have to examine all trigger factors of reaction, such as malaria, anaemia, infection, stress, pregnancy, dental problems. Particularly, chronic ENL cases need more intensive communication. We also sometimes forget "stress factors". We in Papua always screen for malaria and HIV. There is a guideline to use prednisolone and tapering off is an essential issue. In recurrent ENL, we can also treat them with high dose clofazimine and combined with prednisolone tapering off as protocol .However loose clofazimine is not always available. Some dermatologists used methyl prednisolone. Thalidomide is very good for treating ENL however still illegal in my country.
Bolus steroid injection only given in emergency cases when patients cannot swallow drugs , and continued with oral when patients can do it. Sometimes patients repeating vomiting are not always regarding to his/her stomach problems however sometimes crisis of steroid occurs.
Steroid itself is important to prevent nerve damage and to suppress of immune response of inflammation that produce signs of inflammations (oedema, fever, pain, redness and loss of functions: sensory, motor and autonom)
Few cases as not many people mentioned. I found cases with phimosis and sometimes they injected skin of penis, Sexual Transmitted Diseases, orchitis, and white discharge (leucorrhoea) for women. So we need careful physical examination, giving time for consultation and mutual contact is necessary, make patients secure. If I did not find source of infection, however there is sign of inflammation, add antibiotic such as for 5 days may help. No harm to give antibiotic as we understood the leprosy reaction cause of immunological process and if we checked in laboratory usually leucocytosis happened. Home visits is important to understand of family supports and economy. Chronic ENL patients need better nutrients.
In simple words, I would say treat ENL comprehensively.
Thank you very much,
Best wishes
Arry Pongtiku,MD,MHM,PhD
TA for Leprosy Control in Papua and West Papua,in Indonesia.
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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