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Volume - 79, Issue - 3

Editorial
Pages 235 - 238
Editorial
Pages 239 - 241
Review
Pages 242 - 253
Original Papers
Pages 254 - 269
  • Erythema nodosum leprosum in Nepal: a retrospective study of clinical features and response to treatment with prednisolone or thalidomide

    • M. Feuth
    • J. Wim Brandsma
    • W. R. Faber
    • B. Bhattarai
    • T. Feuth
    • A. M. Anderson
    Volume 79, Issue 3

    | Published on September 2008

    Introduction

    Erythema nodosum leprosum (ENL) is an inflammatory reaction, which may occur in the course of leprosy and may result in nerve function impairment and subsequent disability.

    Methods

    This retrospective study explores demographic and disease specific parameters. Severity of ENL was assessed using the Reaction Severity Scale (RSS). Records of 94 patients were reviewed. The study reports also on the treatment of 76 of these patients who were treated with prednisolone alone or thalidomide in addition to prednisolone.

    Results

    Thirty percent of patients presented with ENL at time of diagnosis; 41% developed ENL-reaction in the first year of MDT. Forty-eight percent of patients were treated for ENL-reaction for less than 12 months; 13% for more than 5 years. High RSS-scores correlated with a longer duration of treatment. In group A (prednisolone) 51.7% and in group B (prednisolone and thalidomide) 76.6% of patients were male. Age, leprosy classification, delay of multidrug treatment (MDT) and interval between MDT and first ENL-symptoms did not differ significantly in both groups. Median duration of ENL-treatment was 15 months in group A versus 38 months in group B (P < 0.001). At the start of treatment, ENL-reaction was less severe in group A (RSS = 12) than in group B (RSS = 18; P = 0.003).

    Discussion

    ENL-symptoms may be of help in the early diagnosis and adequate treatment of ENL. Characterisation of (sub) groups of patients with ENL based on presence and severity of symptoms is important for future prospective studies to better evaluate the efficacy of interventions.

Original Papers
Pages 270 - 276
  • Neuropathic pain in people treated for multibacillary leprosy more than ten years previously

    • Paul Saunderson
    • Elizabeth Bizuneh
    • Ruth Leekassa
    Volume 79, Issue 3

    | Published on September 2008

    Objectives

    To identify patients with typical symptoms of neuropathic pain in a well-defined cohort of multibacillary patients being followed up as part of a relapse study in Ethiopia; to identify risk factors for the development of neuropathic pain.

    Design

    96 patients who had completed MDT more than 10 years previously participated in the study, through a questionnaire.

    Results

    28 (29%) had symptoms of neuropathic pain and it was reported as severe in 12. Because the past history of these subjects is well documented, a risk factor analysis was carried out. The presence of leprosy-related impairment was the only significant risk factor for neuropathic pain that was identified.

    Conclusions

    Neuropathic pain is an important problem in a proportion of people previously treated for leprosy. Further research into the management of the condition is required.

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