Severe Erythema nodosum leprosum

What is Severe Erythema Nodosum Leprosum?

Severe erythema nodosum leprosum (ENL) is a severe form of an inflammatory skin disorder caused by leprosy bacilli. It is a reaction that occurs in individuals suffering from leprosy, mainly those with a multi-bacillary form of the disease. ENL most often affects the legs, arms, and upper body, but can also occur on the face and even on the palms of the hands and soles of the feet. Symptoms can include painful red lumps under the skin, fever, weakness, weight loss, and joint pain.

Causes of Severe Erythema Nodosum Leprosum

ENL is caused by an autoimmune reaction triggered by Mycobacterium leprae, the bacteria that causes leprosy. Although the exact mechanism of this reaction is not understood, in some cases, ENL can occur even after the person has been cured of leprosy. It is thought to be the body's reaction to the various antigens that are released during the course of the disease.

Signs and Symptoms of Severe Erythema Nodosum Leprosum

The main signs and symptoms of ENL include:

  • Painful red lumps under the skin
  • Fever
  • Weakness
  • Weight loss
  • Joint pain
  • Joint swelling
  • Skin discoloration
  • Eye irritation

Diagnosis of Severe Erythema Nodosum Leprosum

To diagnose ENL, your doctor will first take a thorough history of your medical condition, including any medications you are currently taking, and perform a physical exam to look for lumps under the skin. Your doctor may also order diagnostic tests such as a blood test to look for leprosy bacilli and an imaging test, such as an MRI, to look for signs of inflammation. The diagnosis is usually made based on the clinical findings.

Treatment of Severe Erythema Nodosum Leprosum

The treatment of ENL depends on the severity of the condition and the underlying cause. In mild to moderate cases, the symptoms can be managed with medications such as analgesics for pain relief, steroids to reduce inflammation, and antibiotics to reduce the risk of infection. In severe cases, hospitalization may be necessary to control the symptoms and complications. The treatment may also include the use of drugs like thalidomide or rifampicin to suppress the immune response.