Utility of the Erythema Nodosum Leprosum International Study Severity Scale for Erythema Nodosum Leprosum: A Clinically Supported Critical Appraisal.

Erythema nodosum leprosum (ENL) is an immune-mediated complication of leprosy. A standardized severity scale based on the clinical signs associated with ENL was developed, piloted, and validated by the Erythema Nodosum Leprosum International Study (ENLIST) group. We conducted a critical appraisal of the ENLIST ENL severity scale using the visit data of eight borderline or lepromatous patients diagnosed with ENL from an outpatient dermatology clinic over a 3-year period. The three most commonly recorded tool criteria observed in the patients were the number, inflammation, and extent of ENL lesions. Fever (including in the preceding 7 days), lymphadenopathy, and inflammation of the joints or digits were rarely encountered (<10%). Score changes reflected treatment progression, with a mean net change of -4.6 over the study period. Most ENLIST scores decreased after immunosuppression was increased (58.5%). Our results suggest that ENLIST accurately reflects ENL severity and treatment. The three tool criteria were not frequently recorded as observed in the patients (<10%). Future studies may be conducted to confirm whether the low frequency of these tool criteria indicates true clinical variability.