BACKGROUND: Lucio's phenomenon is a rare and aggressive necrotising variant of 
erythema nodosum leprosum that classically occur in patients with undiagnosed, 
diffuse non-nodular lepromatous leprosy. It is a potentially fatal leprosy 
reaction characterised by extensive, bizarrely-shaped, painful purpuric skin 
lesions and ulcerations. Lucio's phenomenon is very rarely reported outside of 
Mexico and Costa Rica.
METHODS: We describe 3 cases seen in Johor, Malaysia.
RESULTS: The first two cases responded to the prompt simultaneous institution of 
daily rifampicin, dapsone, clofazimine and prednisolone. Case 3 continued to 
have new lesions and extension of existing lesions while on dapsone and 
clofazimine. The subsequent addition of rifampicin and prednisolone prevented 
new lesion formation but patient succumbed to the extensive cutaneous infarcts 
and consequent sepsis.
CONCLUSIONS: Early diagnosis and prompt institution of multi-drug therapy 
together with prednisolone may improve the prognosis and outcome of Lucio's 
phenomenon.