{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:01:22Z","timestamp":1777075282333,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"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":["Int J Dermatology"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Corticosteroids remain the main therapy in erythema nodosum leprosum (ENL), and long\u2010term usage in chronic or recurrent ENL is a cause of significant morbidity and mortality. Thalidomide exerts dramatic effect in controlling ENL and helps reduce the dose of steroids, but the cost is a hindrance to its usage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients of ENL (steroid na\u00efve and steroid\u2010dependent) were recruited over a 1\u2010year period. An escalating dose of low\u2010dose thalidomide with a reducing dose of prednisolone was titrated depending on the control of disease activity. The primary aim was to reduce the dose of steroids to the lowest effective dose, and the secondary aim was to stop.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen patients of ENL were studied (mean duration of ENL 22.1\u2009months, 15 severe ENL), and a majority (11\/16, 68%) were on steroids with a mean duration of 11.27\u2009months. All patients had steroid\u2010related side effects (cushingoid habitus 81.8%, weight gain 54.5%, diabetes mellitus 9%, hyperlipidemia 18.18%, cataract 18.1%, osteoporosis 36.3%, striae 36.3%, acneiform eruptions 18.1%, and myopathy 9%). Steroids could be tapered in a majority of patients (<jats:italic>n<\/jats:italic>\u2009=\u20099) within 3\u2009months (mean 2.44\u2009months) with a low dose of thalidomide (25\u2013150\u2009mg\/day, mean 78.3\u2009mg) achieving a significant reduction in prednisolone dose (33.16\u2009mg at baseline; 4.28\u2009mg at 3\u2009months, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Steroids could be stopped in 92% of patients by 3.03\u2009months, and both drugs could be stopped in 80% of cases by 5.83\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The rapid and effective control of ENL with low\u2010dose thalidomide in our series is comparable to the historical efficacy of high\u2010dose thalidomide regimens, making it an affordable therapy in resource\u2010constrained settings and an excellent steroid\u2010sparing agent. The rapid onset of disease control is likely attributable to its action via neutrophils.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.16315","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T08:20:41Z","timestamp":1659601241000},"page":"48-55","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A real\u2010world study of low\u2010dose thalidomide in severe erythema nodosum leprosum highlighting its mechanistic rationale in a resource\u2010constrained target population"],"prefix":"10.1111","volume":"62","author":[{"given":"Savitha","family":"Bathula","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1757-3406","authenticated-orcid":false,"given":"Kabir","family":"Sardana","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinu Rose","family":"Mathachan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7020-7777","authenticated-orcid":false,"given":"Ananta","family":"Khurana","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arvind","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Pathology Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Purnima","family":"Paliwal","sequence":"additional","affiliation":[{"name":"Department of Pathology Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002690"},{"key":"e_1_2_6_3_1","first-page":"355","article-title":"Interventions for erythema nodosum leprosum","volume":"80","author":"Van Veen NH","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5025\/hansen.83.111"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.21-0683"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005716"},{"key":"e_1_2_6_7_1","first-page":"215","volume-title":"Jopling \u2018s handbook of leprosy","author":"Narang T","year":"2020"},{"key":"e_1_2_6_8_1","first-page":"186","volume-title":"Jopling \u2018s handbook of leprosy","author":"Khurana A","year":"2020"},{"key":"e_1_2_6_9_1","first-page":"173","article-title":"Occurrence of reactions, their diagnosis and management in leprosy patients treated with multi drug therapy; 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