{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:54:57Z","timestamp":1785826497577,"version":"3.56.0"},"reference-count":5,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>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 (&lt;10%). Score changes reflected treatment progression, with a mean net change of \u22124.6 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 (&lt;10%). Future studies may be conducted to confirm whether the low frequency of these tool criteria indicates true clinical variability.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0871","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T14:31:26Z","timestamp":1753799486000},"page":"731-733","source":"Crossref","is-referenced-by-count":2,"title":["Utility of the Erythema Nodosum Leprosum International Study Severity Scale for Erythema Nodosum Leprosum: A Clinically Supported Critical Appraisal"],"prefix":"10.4269","volume":"113","author":[{"given":"Heather M.","family":"Zimmerman","sequence":"first","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard I.","family":"Frankel","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"},{"name":"Hansen\u2019s Disease Branch, Hawai\u2019i State Department of Health, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Seid","sequence":"additional","affiliation":[{"name":"Hansen\u2019s Disease Branch, Hawai\u2019i State Department of Health, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralina","family":"Karagenova","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarini","family":"Saksena","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao Xin","family":"Liang","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braden","family":"Yoshinaga","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Danko","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas H.","family":"Yim","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Elpern","sequence":"additional","affiliation":[{"name":"The Skin Clinic, Williamstown, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas W.","family":"Johnson","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, Honolulu, Hawaii;"},{"name":"The Queen\u2019s Medical Center, Honolulu, Hawaii"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"PLoS Negl Trop Dis","first-page":"e0006011","article-title":"Clinico-pathological features of erythema nodosum leprosum: A case-control study at ALERT Hospital, Ethiopia","volume":"11","author":"Negera","year":"2017"},{"key":"b2","series-title":"Lepr Rev","first-page":"332","article-title":"The development of a severity scale for erythema nodosum leprosum \u2013 The ENLIST ENL severity scale","volume":"87","author":"Walker","year":"2016"},{"key":"b3","series-title":"PLoS Negl Trop Dis","first-page":"e0005716","article-title":"A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale","volume":"11","author":"Walker","year":"2017"},{"key":"b4","series-title":"International Encyclopedia of Public Health","first-page":"412","author":"Van Brakel","year":"2025"},{"key":"b5","article-title":"National Hansen\u2019s Disease (Leprosy) Program Caring and Curing Since, 1894."}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p731.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p731.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p731.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T17:29:40Z","timestamp":1759339780000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p731.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":5,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0871","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}