In patients with chronic and recurrent erythema nodosum leprosum (ENL), minocycline led to a prompt and sustained improvement of episodes of ENL with minimized side effects when compared with clofazimine, as found from a prospective randomized clinical trial published in Dermatology and Therapy. Researchers aimed to determine safety and efficacy of clofazimine and minocycline (in combination with prednisone) for ENL episodes.

Overall, 60 people were randomly segregated to receive either 100 mg minocycline once daily (n=30) or 100 mg clofazimine thrice daily (n=30) for twelve weeks along with oral prednisolone as per World Health Organization protocol. The recruited people were followed up for six months. The endpoints ascertained were mean time for the initial control of ENL, percentage of people having ENL recurrence, frequency of noxious events, mean time for recurrence following initial control, and additional prednisolone need.

The initial control of ENL was attained earlier in the minocycline group vs. clofazimine group. Both the groups showed comparable ENL flares/recurrences during the study period, as shown in Table 1: 

In comparison with the clofazimine-treated people, minocycline-treated people stayed in remission for a longer duration following the initial management of ENL. Both the groups showed a comparable mean additional prednisolone dose needed for controlling ENL flares/recurrences.

Both minocycline and clofazimine were safe and tolerable. Compared to clofazimine group, the minocycline group exhibited reduced adverse effects. Though both minocycline and clofazimine were effective, minocycline attained faster control and sustained improvement in ENL episodes when compared to clofazimine.