A 22-year-old woman with lepromatous leprosy develops recurrent episodes of erythema nodosum leprosum despite antipyretics and analgesics. She is planning conception soon. Which drug is both the most effective agent for her ENL and absolutely contraindicated in her reproductive plans?

• A Pentoxifylline
• B Clofazimine 300 mg daily
• C Prednisolone 40 mg daily
• D Thalidomide ✓

Explanation

Thalidomide is the most effective drug for severe or recurrent ENL, acting largely through inhibition of tumour necrosis factor alpha. Its catastrophic teratogenicity, causing phocomelia, makes it absolutely contraindicated in women who are pregnant or likely to conceive, and strict pregnancy prevention programmes are mandatory where it is dispensed. Clofazimine and corticosteroids are acceptable alternatives in such patients. Steroids remain the mainstay for ENL with neuritis or orchitis regardless of sex.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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