Resistance as a cause for chronic steroid dependent ENL - a novel paradigm with potential implications in management

Arora, Pooja; Sardana, Kabir; Agarwal, Aastha; Lavania, Mallika

doi:10.47276/lr.90.2.201

Cited by 11 publications

(14 citation statements)

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“…When high dose clofazimine, prednisolone, thalidomide, methotrexate, and colchicine fail to control ENL, simply adding other effective anti-microbial has been known to result in dramatic improvement. 20 In our study, minocycline was given for 12 weeks, and prolonging the duration of therapy may have decreased the number of recurrences and additional prednisolone requirements without increasing the risk of immunosuppression or serious adverse events.…”

Section: Discussionmentioning

confidence: 75%

Comparison of the efficacy and safety of minocycline and clofazimine in chronic and recurrent erythema nodosum leprosum—A randomized clinical trial

Hanumanthu

Thakur

Narang

et al. 2021

Dermatologic Therapy

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Management of chronic/recurrent erythema nodosum leprosum (ENL) is challenging.The majority of these patients become steroid-dependent and suffer from the adverse effects of long-term corticosteroid use. Minocycline has shown promising results in a small series of chronic/recurrent ENL patients. The aim of this study was to compare the efficacy and safety of minocycline and clofazimine in patients with chronic/recurrent ENL. In this prospective randomized clinical trial, 60 participants with chronic/recurrent ENL were randomized (1:1) to receive either minocycline 100 mg once daily or clofazimine 100 mg thrice daily for 12 weeks along with prednisolone according to WHO protocol and followed up for 6 months. The outcome

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Section: Discussionmentioning

confidence: 75%

Comparison of the efficacy and safety of minocycline and clofazimine in chronic and recurrent erythema nodosum leprosum—A randomized clinical trial

Hanumanthu

Thakur

Narang

et al. 2021

Dermatologic Therapy

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“…The focus of resistance surveillance studies so far has been on relapsed cases, with the complete exclusion of reactions in the study group 1 which contrasts with the rising reports of resistance associated with reactions—both ENL and type 1 reaction (T1R) 2–5 (Table 1).…”

Section: Figurementioning

confidence: 99%

“…Thus, an attempt must be made to look for triggers for ENL which can help to modulate the treatment without prolonged steroid administration. The various triggers reported include intercurrent infection, injury, surgery, physical/mental stress, immunizations, a strongly positive Mantoux test, pregnancy and parturition, potassium iodide and antileprosy drugs, and possibly drug resistance 2–5,7 . Common infections causing Type 2 reaction include oral infections, urinary tract infections, sinus infections, respiratory tract infections, hepatitis B and C, malaria, and filariasis 2–5,7 …”

Section: Figurementioning

confidence: 99%

Drug resistance to rifampicin in a case of steroid‐dependent erythema nodosum leprosum and the therapeutic implications of resistance and reactions in leprosy

et al. 2021

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“…[4][5][6][7] More recently, there have been reports of drug resistance as a cause for recalcitrant leprosy lesions and chronic type 2 reactions. 8,9 Erythema nodosum leprosum (ENL) is the cutaneous manifestation of a Type 2 reaction and this can be classified as acute, chronic or recurrent. 10 The aim of this study was to assess the patterns of drug resistance of M. leprae in patients with leprosy relapse and those with chronic/recurrent type (c/r)ENL.…”

Section: Introductionmentioning

confidence: 99%

Equal rates of drug resistance in leprosy cases with relapse and recurrent/chronic Type 2 reaction: time to revise the guidelines for drug‐resistance testing in leprosy?

Narang

Kamat

Thakur

et al. 2021

Clin Experimental Derm

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Background. Leprosy relapse/recurrence is a serious concern particularly in a leprosy-endemic nation such as India. It is believed that bacilli persisting even after multidrug therapy can cause relapse; recently, however, drug resistance as a cause for recurrences and chronic erythema nodosum leprosum (ENL) has been speculated. Aim. To study drug-resistance patterns in cases of leprosy relapse and chronic/ recurrent (c/r)ENL. Methods. This cross-sectional study conducted over a period of 1 year included patients diagnosed as having leprosy relapse and those with c/rENL. Skin biopsy specimens were examined by conventional PCR for resistance testing for rifampicin, dapsone and ofloxacin, respectively targeting the rpoB, folP and gyrA genes of Mycobacterium leprae. Results. In total, 61 patients (25 smear-negative) were included in the study. Of these, 37 were diagnosed as having leprosy relapse and 24 as having c/rENL. Drug resistance to at least one drug was identified in 10 cases (16.4%). Rates of drug resistance were 5.4% (2 of 37) for dapsone, 10.8% (4 of 37) for rifampicin and 2.7% (1 of 37) for ofloxacin among cases of relapse, whereas it was 12.5% (3 of 24) and 8.3% (2 of 24) for dapsone and rifampicin respectively among those with c/ rENL. Multidrug resistance was seen in 3.3% patients (2 of 61). Conclusion. Drug-resistance rate among those with c/rENL was almost equalled that of relapse. Smear-negative leprosy relapse cases also had resistance to bactericidal drugs. These findings call for modifications in criteria for testing under leprosy drug-resistance surveillance and all cases of relapse and those with recalcitrant c/ rENL should be tested.

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Resistance as a cause for chronic steroid dependent ENL - a novel paradigm with potential implications in management

Cited by 11 publications

References 0 publications

Comparison of the efficacy and safety of minocycline and clofazimine in chronic and recurrent erythema nodosum leprosum—A randomized clinical trial

Comparison of the efficacy and safety of minocycline and clofazimine in chronic and recurrent erythema nodosum leprosum—A randomized clinical trial

Drug resistance to rifampicin in a case of steroid‐dependent erythema nodosum leprosum and the therapeutic implications of resistance and reactions in leprosy

Equal rates of drug resistance in leprosy cases with relapse and recurrent/chronic Type 2 reaction: time to revise the guidelines for drug‐resistance testing in leprosy?

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