A Retrospective Study: Epidemiology, Onset, and Duration of Erythema Nodosum Leprosum in Surabaya, Indonesia

Abstract

Background: Erythema nodosum leprosum (ENL) has a chronic and recurrent nature which could reduce patient’s quality of life in addition to the onset of ENL that occurs before, during, or after multidrug treatment, further emphasizing the importance of regular control and education.Purpose:This study aimed to evaluate the epidemiology, onset, duration, and recurrence of ENL. Methods:Data from medical records were obtained for a 3-year retrospective study of multibacillary leprosy patients at the Leprosy Division of the Dermatology and Venereology Outpatient Department, Dr. Soetomo General Hospital Surabaya, with a minimum of 2–5 years follow-up period.Result:The prevalence of ENL continued to increase almost every year especially in 2017 (32% in 2015; 32% in 2016; and 36% in 2017). ENL most often occurs during the first year of multi-drug therapy (MDT) administration followed by after the release from treatment (RFT) with the latest onset occurring 4 years after RFT. The majority of patients experienced chronic and recurrent reactions with the longest reactions lasting up to 4.5 years (55 months). Conclusion:Knowledge about the onset, duration, and recurrences of ENL are essential, and strict supervision for routine control shall be encouraged to increase the patients’ compliance so as to increase their quality of life.

Diagnostic Value of Neutrophil-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio, and Platelet-to-Lymphocyte Ratio in the Diagnosis of Erythema Nodosum Leprosum: A Retrospective Study

“…This study describes the distribution and clinical characteristics of ENL, showing a relatively low incidence corresponding to 12.09% of all new MB patients. A previous study by Fransisca C., et al [ 13 ] in the same hospital in 2015–2017 reported a higher ENL incidence of 33% in all MB cases. This difference may be related to the fact that in this study, we eliminated a group of patients, who could have been suffering from ENL but did not perform the necessary laboratory analysis to complete the study.…”

“…Ironically, MDT used for leprosy treatment, which leads to bacterial fragmentation, is hypothesized to elicit the formation of antigen–antibody complexes in ENL [ 12 ]. The cause–effect relationship between MDT treatment and ENL explains the higher incidence of ENL found in patients on MDT therapy or after being released from MDT, in comparison to newly treated patients [ 12 , 13 ]. The incidence of ENL during MDT can be at least twice higher than that at the time of initial diagnosis [ 11 ].…”

Borderline Lepromatous Leprosy with Severe Erythema Nodosum Leprosum: A Case Report

“…Knowledge of the clinical course of ENL is important and close monitoring during follow-up is necessary to increase patient adherence to treatment. 25 Patients should also be educated about the disease and the possibility of disease transmission; the medications taken by the patient and their side effects; other possible complications of nerve damage (eyes, hands, and feet); and follow-up schedules.…”