Clofazimine in recurrent type 2 (ENL) leprosy reaction

Leprosy Mailing List – September 2^nd, 2010

Ref.:    Clofazimine in recurrent type 2 (ENL) leprosy reaction.

From:  Pieter AM Schreuder, Maastricht, The Netherlands

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Dear Dr. Romero,

Thank you very much for your message dated LML Aug. 29th, 2010.  May I refer you to the following:

Chronic recurrent ENL, steroid dependent: long-term treatment with high dose clofazimine. Schreuder PA, Naafs B.Lepr Rev. 2003 Dec;74(4):386-9

Just to quote one paragraph:

"Patients who develop several bouts of ENL over a short period of time should be prescribed a high dose of clofazimine with a starting dose of 300mg daily for at least 2 months, together with drugs to relieve the acute symptoms (e.g. steroids). When a patient continues having ENL reactions, 200-300 mg daily should be maintained for longer periods, and if the patient is on steroids, the steroids should be reduced slowly (to zero) under the protective umbrella of clofazimine. When thalidomide is available and can be prescribed, it could be used or added to replace the steroids.  If no new ENL reactions appear and the patient is no longer on steroids, clofazimine can slowly be reduced to 200mg daily for 2 months, to 100mg daily for 2 months, etc. Clofazimine can be given in high doses over long periods to wean dependent patients from steroids."

In Thailand, we did not have thalidomide, and basically had only two drugs: steroids and clofazimine.  A course of high doses clofazimine as mentioned above was used with excellent results in chronic ENL and steroids dependent ENL.  However, in some cases it took one year to wean the patient from the steroids.  I also remember several patients on high dose clofazimine with a long history of chronic ENL who refused when I wanted to reduce the clofazimine fearing that the ENL would come back.

Kind regards,

Pieter AM Schreuder