Leprosy
mailing list – October 12th, 2006
Ref.: Treatment
of recurrent ENL reaction
From: Bryceson
A., London, UK
Dear
Dr Strahm,
I refer to your message (LML
Sept. 27th, 2006). I
would suggest that you return to thalidomide. Start at 400 mg/day and
reduce gradually as the reaction comes under control, usually after a
few days to 300 then more slowly to 200, 100 and hold it at 100mg/day. Now you can get the
clofazimine down to 100 and start to withdraw the prednisolone. Finally after some months you
can try to reduce the thalidomide; but do not be in a hurry; it might
take a year or so for the reaction to subside. Monitor nerve function
carefully, as this will tell you if you are giving adequate drug.
Best wishes,
Anthony
