SynthesisPLoS neglected tropical diseases2013
A systematic review on the epidemiological data of erythema nodosum leprosum, a type 2 leprosy reaction.
Synthesis in PLoS neglected tropical diseases, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 2 syntheses or guidelines pooled it, 103 citations in OpenAlex.
- A systematic review of adverse effects associated with systemic corticosteroids in the management of leprosy.PLoS neglected tropical diseases · 2026Pooled it
- Inflammatory Mediators of Leprosy Reactional Episodes and Dental Infections: A Systematic Review.Mediators of inflammation · 2015Pooled it
- Methotrexate and Prednisolone compared to placebo and prednisolone in the treatment of severe Erythema Nodosum Leprosum: An international multicentre, double-blind randomised controlled clinical trial-MaPs in ENL.PLoS neglected tropical diseases · 2026Trial
- International open trial of uniform multidrug therapy regimen for leprosy patients: Findings & implications for national leprosy programmes.The Indian journal of medical research · 2016Trial
- Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised, Double Blind, Controlled Pilot Studies in Ethiopia.PLoS neglected tropical diseases · 2016Trial
- Safety and efficacy assessment of two new leprosy skin test antigens: randomized double blind clinical study.PLoS neglected tropical diseases · 2014Trial
- Neutrophil-to-lymphocyte ratio as a biomarker in erythema nodosum leprosum: A systematic review and meta-analysis.New microbes and new infections · 2026Review
- Dovramilast for Erythema Nodosum Leprosum in Patients With Leprosy in Nepal: Protocol for a Phase 2 Open-Label Pilot Study.JMIR research protocols · 2026Article
- Differential regulation of neutrophil degranulation by p38 MAPK and mitochondrial ROS duringFrontiers in pharmacology · 2026Article
- A socio-ecological model of the management of leprosy reactions in Indonesia and India using the experiences of affected individuals, family members and healthcare providers.BMC health services research · 2025Article
- Healthcare performance of leprosy management in peripheral health facilities of Dhanusa and Mahottari, Nepal.BMC health services research · 2025Article
- Leprosy.Nature reviews. Disease primers · 2024Review
- A case report and literature review: Mycobacterium leprae infection diagnosed by metagenomic next-generation sequencing of cerebrospinal fluid.BMC infectious diseases · 2024Review
- Erythema nodosum leprosum necroticans: a case report of an atypical severe type 2 leprosy reaction and literature review.Le infezioni in medicina · 2024Article
- Article
- Review
- Neutrophilic leukocytosis and erythema nodosum leprosum in leprosy: insights from a retrospective observational study.Frontiers in immunology · 2024Observational
- Review
- A history of thalidomide in India.Medical history · 2023Article
- Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundErythema Nodosum Leprosum (ENL) is a humoral immunological response in leprosy that leads to inflammatory skin nodules which may result in nerve and organ damage, and may occur years after antibiotic treatment. Multiple episodes are frequent and suppression requires high doses of immunosuppressive drugs. Global occurrence is unknown. METHODOLOGY/PRINCIPAL
findingsSystematic review of evidence on ENL incidence resulted in 65 papers, predominantly from India (24) and Brazil (9), and inclusive of four reviews. Average incidences are based on cumulative incidence and size of study populations (n>100). In field-based studies 653/54,737 (1.2%) of all leprosy cases, 194/4,279 (4.5%) of MB cases, and 86/560 (15.4%) of LL cases develop ENL. Some studies found a range of 1-8 per 100 person-years-at-risk (PYAR) amongst MB cases. Hospital samples indicate that 2,393/17,513 (13.7%) of MB cases develop ENL. Regional differences could not be confirmed. Multiple ENL episodes occurred in 39 to 77% of ENL patients, with an average of 2.6. Some studies find a peak in ENL incidence in the first year of treatment, others during the second and third year after starting MDT. The main risk factor for ENL is a high bacteriological index. CONCLUSIONS/SIGNIFICANCE: Few studies reported on ENL as a primary outcome, and definitions of ENL differed between studies. Although, in this review averages are presented, accurate data on global and regional ENL incidence is lacking. Large prospective studies or accurate surveillance data would be required to clarify this. Health staff needs to be aware of late reactions, as new ENL may develop as late as five years after MDT completion, and recurrences up to 8 years afterwards.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.