Leprosy
mailing list – October 16th, 2006
Ref.: Treatment
of recurrent in ENL reaction.
From: Theuvenet W. J.,
Apeldoorn, The Netherlands
Dear Dr.
Strahm,
I refer to your message: LML Sep. 27th , 2006. Several colleagues have
already commented on the possibilities of various drug regimes for the
treatment of recurrent ENL.
When combining high dosages of Clofazimine with NSAID's one may
need to keep a close eye on the increased risk of latent gastric
bleeding as this easily can become fatal to the patient.
Besides feelings of a strong malaise, many patients
suffer from extreme pain in the affected peripheral nerves, which
often only partially responds to the above mentioned drug regimes. In those cases one can
consider performing a nerve decompression over the length of the nerve
that is affected. In my
experience the nerve pain responds well to this treatment, the
procedure does not affect nerve function when well performed, and
after the intervention it may be easier to taper of the high dosages
of anti-inflammatory drugs. Details of the procedure were
published in the Eur. J. Plast. Surgery (2006) 28; 393-399 : "Change
of Sensation in Leprosy by Selective Meshing of the Epineurium".
Wishing you and your patients all the best,
Willem J. Theuvenet, M.D., Ph.D.,
Consultant Plastic and Reconstructive Surgery
for TLMI and the NLR.
