British Leprosy Relief Association
The development of a severity scale for Erythema Nodosum Leprosum – the ENLIST ENL severity scale
S. L. Walker et al.
ENLIST ENL Severity Scale
NeryJosé A. C.k
LockwoodDiana N. J.a
on behalf of the Erythema Nodosum Leprosum International STudy Group†
aFaculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
bRoyal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
cBombay Leprosy Project, Mumbai, India
dFaculty of Health Sciences, University of Southampton, Southampton, United Kingdom
eDr Soetomo General Hospital, Surabaya, Indonesia
fThe Leprosy Mission International, Bangladesh
gThe Leprosy Mission Hospital, Purulia, India
hAnandaban Hospital Kathmandu, Nepal
iALERT Center Addis Ababa, Ethiopia
jLeonard Wood Memorial Center for TB and Leprosy Research, Cebu, Philippines
kFIOCRUZ, Rio de Janeiro, Brazil
Correspondence to: Steve Walker, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT (e-mail: firstname.lastname@example.org)
The other members of the Erythema Nodosum Leprosum International STudy (ENLIST) Group at the time of the meeting referred to in this manuscript are listed in the acknowledgements.
Erythema nodosum leprosum (ENL) is a severe, multi-system complication of leprosy which is difficult to manage. The evidence for effective treatment is limited and defining outcome measures for clinical trials is difficult. There are no validated measures of disease severity and so we wished to develop a clinical severity scale.
Three published scales that had been used in ENL research were applied to patients with ENL at six leprosy referral centres. An analysis of the clinical features associated with ENL severity was performed on data obtained from the ENLIST 1 study. A meeting of experienced leprosy researchers was held to incorporate the findings from the scale testing and data analysis into a clinical severity scale for ENL Results: None of the three scales used were found to be ideal but some features of each were incorporated into a new scale along with novel items felt to be appropriate. A final 16 item scale – the ENLIST ENL Severity Scale was agreed by the meeting participants and detailed notes and definitions developed.
We have developed a new severity measure for ENL which we propose to subject to formal validation.