Experiences with Thalidomide for Erythema Nodosum Leprosum– a retrospective study

Background: Thalidomide is well known as a steroid sparing drug in Erythema Nodosum leprosum (ENL) reaction in leprosy. There is no guideline as to when it should be offered to patients. Documentation of ENL presentation with its morbidity before and after with patient profile can be a baseline to develop a selection criteria as to when thalidomide should be started to reduce steroid related morbidly. Method: Chart and electronic record review was done. Result: 427 ENL patients attended the hospital from 2010 to 2014. 73 patients (67 males six females) were treated with thalidomide. 77% (56) patients were in the age group of 16–45 yrs. 16% (12) were dependent and 39% (29) were taking steroids at presentation. 82% (60) became dependent while on treatment. Ninety five percent were chronic or recurrent ENLs and 73% (53) had moderate to severe ENLs over 49 median months. Steroid induced morbidities were (Cushingoid features 42%, diabetes 21%, infections GI 42%, genitourinary 26%, cataract 23%). There was 11% mortality. Conclusion: Further studies are recommended to diagnose steroid dependence early to prevent serious adverse effects.