The Effect of Stopping Dapsone Treatment for Two Months and then Restarting it in Full Dosage in Patients with Moderately SevereErythema Nodosum Leprosum

Abstract

Nine patients suffering fro m persistent, moderately severe ery/hema nodosum leprosum (ENL) were included in this study. During a period of 8 or 10 weeks when anti-leprosy treatment with dapsone was replaced by a placebo capsule, there was a fall in the severity of the ENL wh.ich just attained statist ical significance. When dapsone treatment was restarted in full dosage (100 mg daily), using a capsule identical to the placebo, there was no effect on the ENL for the first 2 weeks, and a slight (but statistically insignificant) increase in its severity thereafter. Erythema nodosum leprosum (ENL) was first recognized, and indeed named. long

The Relationship of Dapsone (DDS) Therapy toErythema Nodosum Leprosum. Is it Direct or Indirect?

“…The trial was designed to include not only the ab rupt starting of 100 mg dapsone daily-a dose widely considered to be sufficient to precipitate or exacerbate ENL in many reaction-prone patients-but also a second control period of at least three weeks' duration. The latter enabled us to investigate any delayed dapsone effect, such as appeared to occur in the third and fourth weeks after restarting dapsone in sulphone-sensitive, moderately severe ENL patients (Pearson and Helmy, 1973). No immediate or delayed effect was detected.…”

“…The design of the trial was based on the methods developed at the Leprosy Research Unit for testing the effect of drugs against established ENL (Pearson and Vedagiri , 1969 ;Waters, 1971 a; Helmy et ai., 1971;Pearson and Helmy, 1973).…”

Leprosy reactional states and their treatment

“…(2) ENL is not always aborted by stopping dapsone and if it is subsequently restarted immediate worsening of the reaction is not produced (Pearson & Helmy, 1973), Dapsone has been shown to have a beneficial effect in the treatment of experimentally produced Arthus reactions in guinea-pigs (Thompson & Souhami, 1975) and it may be that it has some beneficial effect on the Arthus reaction of ENL, If simple measures such as rest and reassurance are insufficient to control the reaction, and if complications such as iritis and neuritis develop, then additional therapy is urgently indicated.…”

Problems and Opportunities in the Therapy of Leprosy

“…In fa ct, many clinicians over the past two or three decades have gained a strong impression that the incidence and severity of lepra reactions are dosage dependent. However, a preliminary trial in lepromatous patients at Sungei Buloh, Malaysia, has failed to confirm this impression (Pearson and Helmy, 1973), and further controlled trials on this important subj ect are indicated.…”