“…6,7 Several agents have been used to treat ENL, including thalidomide, corticosteroids, clofazimine, CyA, azathioprine, pentoxifylline, mycophenolate mofetil, methotrexate and i.v. immunoglobulin G. 8,9 The efficacy of thalidomide in the treatment of lepra reactions was first reported by Sheskin in 1965, 10 and its efficacy (68-91%) has since been confirmed in multiple studies, [11][12][13] attributed to its inhibitory actions on tumor necrosis factor (TNF)-a. It has been noted that serum TNF-a levels are higher in patients with ENL compared with normal individuals, and elevated TNF-a levels decrease with thalidomide treatment.…”