title: Using methotrexate to treat patients with ENL unresponsive to steroids and clofazimine: a report on 9 patients.
abstract: Erythema nodosum leprosum (ENL) is a chronic recurrent systemic complication of multi-bacillary leprosy frequently associated with the development of neuritis, iritis, orchitis, arthritis and dactylitis. It is well managed by thalidomide, but thalidomide is not available in Bangladesh. The World Health Organization recommends high doses of clofazimine and prednisolone. About 19% of patients do not respond completely to this regimen or experience relapse when reducing steroid dosage.
  
  
  OBJECTIVE
  We undertook this study to determine whether oral prednisolone combined with methotrexate was an effective and safe treatment regimen for individuals with ENL resistant to clofazimine and prednisolone.
  
  
  METHODS
  Between September, 2006-June, 2011, we treated nine resistant ENL patients with a combination of prednisolone and methotrexate for 24-36 months with a mean duration of 30 months.
  
  
  RESULTS
  We observed improvement leading to persistent remission of ENL in all our patients. Adverse effects were mild weight gain, weight gain with facial swelling, folliculitis and extensive Pityriasis versicolor infection in one patient and crusted scabies in another.
  
  
  CONCLUSIONS
  A combination of prednisolone and methotrexate was safe and effective in managing ENL not controlled by clofazimine and prednisolone.
authors.forename: Delwar
authors.initials: D
authors.lastname: Hossain
mesh_terms: D000328:Adult; D002991:Clofazimine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004893:Erythema Nodosum / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007917:Leprostatic Agents / Q000627:therapeutic use*; D056006:Leprosy, Multibacillary / Q000150:complications*; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007917:Leprostatic Agents; D011239:Prednisolone; D002991:Clofazimine; D008727:Methotrexate