Using Methotrexate to treat patients with ENL unresponsive to steroids and clofazimine: A Report on patients

摘要

Introduction: Erythema nodosum leprosum (ENL) is a chronic recurrent systemiccomplication of multi-bacillary leprosy frequently associated with the developmentof neuritis, iritis, orchitis, arthritis and dactylitis. It is well managed by thalidomide,but thalidomide is not available in Bangladesh. The World Health Organizationrecommends high doses of clofazimine and prednisolone. About 19% of patientsdo not respond completely to this regimen or experience relapse when reducingsteroid dosage.Objective: We undertook this study to determine whether oral prednisolonecombined with methotrexate was an effective and safe treatment regimen forindividuals with ENL resistant to clofazimine and prednisolone.Methodology: Between September, 2006– June, 2011, we treated nine resistantENL patients with a combination of prednisolone and methotrexate for 24 –36months with a mean duration of 30 months.Result: We observed improvement leading to persistent remission of ENL in all ourpatients. Adverse effects were mild weight gain, weight gain with facial swelling,folliculitis and extensive Pityriasis versicolor infection in one patient and crustedscabies in another.Conclusion: A combination of prednisolone and methotrexate was safe andeffective in managing ENL not controlled by clofazimine and prednisolone