{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T21:45:27Z","timestamp":1749678327882},"reference-count":67,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T00:00:00Z","timestamp":1621900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Deutsche Derma Gesell"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Classic erythema nodosum leprosum (ENL) is characterized clinically by abrupt eruption of tender erythematous nodules, papules and plaques. Variable atypical patterns have been described, for example pustular, bullous, ulcerative, necrotic and Sweet\u2019s syndrome\u2010like ENL. We aim to review previously reported cases of atypical ENL addressing the diagnostic and therapeutic aspects of these uncommon presentations. A search of medical literature for all cases of atypical ENL was conducted in the PubMed database till 2020. Data of patients with atypical ENL were collected and analyzed to describe the epidemiological, clinico\u2010histological and therapeutic features. The major five clinically described presentations of atypical ENL include vesiculo\u2010bullous lesions (46\u00a0% of patients), ulcero\u2010necrotic lesions (41\u00a0%), erythema multiforme\u2010like lesions (28\u00a0%), Sweet\u2019s syndrome\u2010like lesions (11\u00a0%) and pustules (9\u00a0%). The skin lesions were accompanied by fever and constitutional symptoms in all patients. Oral steroids and thalidomide were the main lines of therapy in most of the reported patients. Dermatologists and pathologists should keep in mind the clinical variability of ENL to avoid misdiagnosis and delayed management. Early recognition can help control disease progression and save the patients from further complications.<\/jats:p>","DOI":"10.1111\/ddg.14449","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T12:39:02Z","timestamp":1621946342000},"page":"1133-1143","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects"],"prefix":"10.1111","volume":"19","author":[{"given":"Rania","family":"Alakad","sequence":"first","affiliation":[{"name":"Department of Dermatology Faculty of Medicine Zagazig University  Zagazig Egypt"},{"name":"Member of Interactive Dermatology Foundation Research group"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Nofal","sequence":"additional","affiliation":[{"name":"Department of Dermatology Faculty of Medicine Zagazig University  Zagazig Egypt"},{"name":"Member of Interactive Dermatology Foundation Research group"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda","family":"Assaf","sequence":"additional","affiliation":[{"name":"Pathology Department Faculty of Medicine Zagazig University  Zagazig Egypt"},{"name":"Member of Interactive Dermatology Foundation Research group"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.94278"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsi.2016.06.005"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.5455\/2349-3933.ijam20150525"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1987.tb02293.x"},{"key":"e_1_2_7_6_1","first-page":"293","article-title":"Necrotic erythema nodosum leprosum: a presenting manifestation of lepromatous leprosy","volume":"61","author":"Verma KK","year":"1993","journal-title":"Int J Lepr Other Mycobact Dis"},{"key":"e_1_2_7_7_1","first-page":"27","article-title":"Caracter\u00edsticas cl\u00ednicopatol\u00f3gicas dos estudos reacionais na Hansen\u00edase em pacientes submetidos \u00e0 poliquimioterapia (PQT)","volume":"74","author":"Nery JC","year":"1999","journal-title":"An Bras Dermatol"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2002.1428_2.x"},{"key":"e_1_2_7_9_1","first-page":"206","article-title":"Bullous reactions in leprosy: a rare phenomenon","volume":"70","author":"Dogra S","year":"2002","journal-title":"Int J Lepr"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.5070\/D321V2P87G"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.47276\/lr.75.2.177"},{"issue":"2","key":"e_1_2_7_12_1","first-page":"122","article-title":"Erythema nodosum leprosum necroticans in a child \u2013 an unusual manifestation","volume":"73","author":"Pandhi D","year":"2005","journal-title":"Int. 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