Fw: Ref.: (LML) A critical appraisal of the ENLIST severity scale for erythema nodosum leprosum

 
Leprosy Mailing List – May 4,  2022

 

Ref.:  (LML) A critical appraisal of the ENLIST severity scale for erythema nodosum leprosum

From:  Ben Naafs, Munnekeburen, the Netherlands

 

Dear Pieter,

 

I just read a to-the-point paper on PLOS NTD by Bhushan Kumar, Hitaishi Mehta,Tarun Narang and Sunil Dogra: "A critical appraisal of the ENLIST severity scale for erythema nodosum leprosum". https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010378

 

Their closing paragraph of this article suggests the following:

"We would suggest that in the next revision of this useful scale, the authors should consider adding that presence of iritis/ iridocyclitis, orchitis, ulcerated/ necrotic skin lesions, and severe neuritis (even in the absence of skin lesions), whatever may be the score, should be labelled as severe ENL. This approach is similar to the lines on which authors have decided to categorize chronic ENL under 'severe' disease (even when the symptoms and signs do not qualify for that label) being fully aware that the episode of reaction is not always 'severe' in degree–; it is the sequelae that are of importance even if they affect a minority of the patients. So, for scoring, it should not matter when an important/ vital organ is involved in 1in 10 or 1 in 1000 patients. Further, various ambiguities in the terminology for scoring should be clarified–if the scale is intended to be ultimately used by health workers, physiotherapists or general duty medical officers involved in care of leprosy affected people."

 

 

I have always had difficulties using the ENLIST scale, and continue to use clinical impressions as before. The more, because it is an intermittent severe illness superimposed on the chronic Lepromatous Leprosy that except from acute damage to the eyes and testes usually leads to minimal damage to the nerves and other organs. As a researcher, I felt some guilt because I could not compare my findings and results with some other papers. But as a clinician, I felt comfortable and could still compare with others who used their clinical impression too. A scale would be useful, but it should be easily applicable for a clinician without too much time.

 

Maybe a topic for the congress in Hyderabad?

 

Ben

 

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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