# Split Dose of Prednisolone in the Treatment for Erythema Nodosum Leprosum: A Case Series

## TL;DR

Splitting the dose of prednisolone helps treat ENL effectively with fewer side effects and relapses compared to higher single doses.

## Contribution

Split-dose prednisolone offers better control of ENL with reduced steroid dependency and relapse rates.

## Key findings

- Eight ENL cases showed dramatic response to split-dose prednisolone.
- No relapses or HPA axis suppression were observed with the split-dosing regimen.
- Split dosing provides effective ENL control with fewer side effects.

## Abstract

Background

Erythema nodosum leprosum (ENL) is an immune complex-mediated reaction that clinically presents as tender erythematous evanescent nodules, mostly associated with systemic symptoms. Oral prednisolone is the drug of choice, with doses ranging from 0.5 to 1 mg/kg. Some cases may develop new lesions and systemic symptoms despite 1 mg/kg prednisolone, and in ideal practice, physicians escalate the prednisolone dose for immediate arrest of inflammation to prevent complications. However, a high dose of prednisolone has more side effects in the long term and causes more immunosuppression.

Methods

In cases of ENL, those not responding to a conventional once-daily regimen were given a split dose of oral prednisolone instead of increasing the dose. They were followed up for response, and serum cortisol was measured to see for hypothalamic-pituitary-adrenal (HPA) axis suppression.

Results

Eight cases of ENL (three nodular, three necrotic, one pustular, and one nodulcerative) had a dramatic response to split-dose therapy without any relapse and HPA axis suppression.

Conclusion

A split-dosing regimen can be a good treatment option in ENL with better control, less steroid dependency, and a lower relapse rate.