Transitioning Steroid-Dependent Erythema Nodosum Leprosum to Methotrexate-Based Management: A Literature Review Achmad Syarifhidayatullah1, Medhi Denisa Alinda2*, Tri Pudy Asmarawati3, Linda Astari2 Abstract Erythema nodosum leprosum (ENL) is a devastating immune system disorder that affects up to 50% of lepromatous leprosy patients. It causes recurring painful nodules and body-wide inflammation. Current