Work

Lucio’s phenomenon and necrotic erythema nodosum leprosum: a global review of clinical presentations and management (2019–2026)

Year: 2026

Type: article

Abstract: Background. Necrotic variants of leprosy reactions, specifically Lucio phenomenon (LP) and necrotic erythema nodosum leprosum (nENL), represent severe, potentially life-threatening manifestations of Hansen's disease. These conditions may involve vascular damage, thrombosis, and extensive cutaneous necrosis, although their underlying mechanisms differ. Aim. This review describes the clinical characteristics, geographical distribution, and reported management approaches for LP and nENL between 2019 and 2026. Methodology. An extensive literature survey was conducted across PubMed, ScienceDirect, and EMBASE using keywords related to Hansen's disease and atypical manifestations, including “necrotic,” “ulcerative,” “Lucio phenomenon,” and “vasculonecrotic.” Inclusion criteria focused on primary clinical evidence, including case reports and case series, published from January 2019 to March 2026. Results. The compiled table contains 66 clinical entries from 21 countries. India and Indonesia account for 31 entries (47.0%). Clinical manifestations included punched-out necrotic ulcers, stellate plaques, and hemorrhagic bullae. Although high bacillary indices (BI 5+ to 6+) were frequently reported, severe reactions also occurred at lower indices. Management approaches included multidrug therapy, systemic corticosteroids, and, in selected patients, thalidomide. Surgical debridement was required in some cases with extensive tissue necrosis, while anticoagulants were reported in selected cases with thrombotic complications. Conclusion. Early recognition of LP and nENL is critical, particularly in nonendemic regions where these manifestations may resemble other forms of vasculitis. Appropriate diagnosis and individualized management are essential in reducing complications and improving clinical outcomes.

Source: Romanian Medical Journal

DOI: 10.37897/rmj.2026.3.14

Authors: Aseer Manilal, Naz Kamaran Ahmed, Kozhir Karim Abdalla, Nabaz Hamarashid Hama, KR Sabu

Institutions: Komar University of Science and Technology, Arba Minch University

Language: English

Topic: Leprosy Research and Treatment

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $192