Erythema nodosum leprosum research: ENLISTing support.

Understanding and managing leprosy reactions and their associated nerve function impairment remain a research priority for WHO and form part of the International Federation of Anti Leprosy Associations (ILEP) Strategy 2015-18. We still lack the tools to predict who will develop these serious complications which lead to nerve function impairment, disability and other long term sequelae, such as neuropathic pain. Erythema Nodosum Leprosum (ENL, Type 2 leprosy reaction) is a severe multi-system disorder characterised by tender crops of cutaneous lesions, neuritis, fever and inflammation of the joints, testes, eyes and bones. ENL is often a chronic condition requiring long term treatment and is associated with severe morbidity, financial hardship and death. The Erythema Nodosum Leprosum International Study (ENLIST) Group met in Mumbai in April this year hosted by the Bombay Leprosy Project. The meeting report is published in this edition of Leprosy Review. The main aims of the meeting were to form a consensus on a severity scale for ENL and the methodology to validate it. The development of the ENLIST ENL Severity Scale represents a significant step forward in developing robust outcomes for clinical studies of ENL and may also prove of value in future laboratory studies. The ENLIST Group consists of clinicians and laboratory scientists working at leprosy centres in Bangladesh, Brazil, Ethiopia, India, Indonesia, Nepal, the Philippines and the United Kingdom. The group was founded at a meeting in Cebu in 2012 with the aims of improving: the understanding of the mechanisms underlying ENL, the evidence to guide treatment decisions and access to effective treatments. The first project of the ENLIST collaboration was the systematic collection of data on the clinical features of ENL. This was initially presented at the International Leprosy Congress in Brussels in 2013, where the second ENLIST meeting was held, and has now been published. The group is currently analysing data collected on the quality of life of patients with ENL. The Leprosy Research Initiative recently awarded the group a grant to validate the ENLIST ENL Severity Scale and that work has now started. The pathogenic mechanisms underlying the onset of both Type 1 reactions and ENL are not well understood, nor are the reasons for the continuing inflammation seen in these states. The effective treatment of reactions is hampered by delays in presentation and diagnosis. However once patients are diagnosed, the treatment prescribed may not fully restore function Lepr Rev (2015) 86, 304–306