Leprosy Mailing List – November 6th,
2006
Ref.: Treatment of
erythema nodosum leprosum (ENL) reaction
From: Ahmad
L., Karachi,
Pakistan
Karachi, October 24th, 2006
Dear Salvatore,
Greetings on EID-UL-FITAR and thank you for
sending a series of LMLs on recurrent ENL reaction in leprosy.
Dr Warren's view-point on
this topic (LML Oct. 20th, 2006) is undoubtedly true
(as she is a textbook herself). However,
if I may add, use of cortisone in type II (ENL) and type I
downgrading reactions (Joplin) add significantly in recurrence of
reactions and should be discouraged, especially among paramedics
in field.
Clofazimine (Lamprene) is
still a wonderful drug in the management of ENLs and unlike early skin
discoloration among Chinese, brown skin of south Asians tolerate it
very well and for longer periods.
Dermal photosensitivity in pre- Monsoon and Ichthyosis in dry
winter do pose some problems. Clofazimine
is a fat-soluble pigment which is readily taken up by reticulo-endothelial
cells of gastro-intestinal tract like Payer's patches. The patients who take low-fat
diet are at a risk of getting regional ileitis. I recall two decades back when
in Karachi inpatients who were kept on high doses of clofazimine used
to get a luxurious chunk of butter in their break-fast, GI symptoms
were less common then.
Thank you again,
Dr Latif Ahmad
