Thalidomide in the treatment of erythema nodosum leprosum

Abstract

Forty‐four trials of thalidomide or an identical placebo have been conducted in 22 patients with active lepromatous leprosy and chronic erythema nodosum leprosum (ENL) reactions. Thalidomide is significantly superior to placebo in completely alleviating the two principal signs of ENL, fever and skin lesions. Selected serial laboratory determinations during the study demonstrate an acute anemia occurring in and immediately after EN L and an acute rise in circulating leukocytes with a shift to the left in the differential count. There is an acute increase in both direct and indirect serum bilirubin associated with ENL and a fall in total serum cholesterol. The suggestion is made that ENL has some characteristics of the disseminated intravascular coagulation syndrome. Despite its teratogenic effect, thalidomide is less toxic than corticosteroids and therefore seems to represent a major advance in the management of ENL. Its mechanism of action in ENL is unknown.