Leprosy Mailing List - May 20th, 2007
Ref.: A
complicated case of recurrent ENL reaction
From: Lockwood D., London, UK
Ref.: Dr
Ogbeiwi's message, LML May 12th, 2007
Dear Salvatore,
I agree with Anthony (LML May
18th, 2007) that Thalidomide would be best for this man. He illustrates very well the
paradox of ENL that one needs immunosuppression to halt the ENL but
that steroids can sometimes be life threatening.
If Thalidomide is not available then the possibilities of
using other immunosuppression should be explored- azathioprine,
cyclosporine or pentoxyfiline could all be tried. Clofazimine really works very
slowly and only as a mild immunosupressant.
There might also be a role for national programme mangers /
ILEP co-ordinators arranging access to second line drugs for these
difficult to manage cases. It
is striking how many of the difficult to manage cases on the LML are
ENL cases.
I would
not be keen on giving sedation.
Best
wishes,
Diana
***************************************************************************
Diana Lockwood
Professor of Tropical Medicine
Head of Clinical Research Unit
London School of Hygiene & Tropical Medicine
Keppel St
London WC1E 7HT
diana.lockwood@lshtm.ac.uk
Tel: 020 7927 2457
Fax: 020 7637 4314
