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Thalidomide in Cutaneous Lupus Erythematosus

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Abstract

For nearly 50 years, thalidomide has struggled between success and controversy. After causing an epidemic of phocomelia and other birth defects during the 1960s, affecting thousands of neonates, thalidomide was used as a sedative in selective disorders including leprosy. The potent anti-inflammatory properties of thalidomide were serendipitously discovered while treating patients with erythema nodosum leprosum, and the drug is now approved by the US FDA for the treatment of this disease. Subsequently, the immunosuppressant effects of thalidomide, including the complex modulation of many cytokines, have been recognized. One promising application of thalidomide has been the treatment of cutaneous lupus erythematosus. Among the largest series reviewed, the drug has been found to ameliorate cutaneous lupus erythematosus in 90% of patients, on average. Remission is achieved in approximately 15–20% of patients with cutaneous lupus erythematosus at doses between 50–400mg daily. Contraceptive concerns and the recognized neuropathic effects of thalidomide limit the use of the drug in patients with cutaneous lupus. Physicians who prescribe thalidomide in the US must be registered with the drug manufacturer. With appropriate control of drug access and close physician monitoring, thalidomide provides a needed therapeutic option for the treatment of refractory cases of cutaneous lupus erythematosus.

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Acknowledgements

The authors have no conflicts of interest regarding the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Dermatology, School of Medicine, University of Pennsylvania, 36th and Spruce Streets, Philadelphia, Pennsylvania, 19104, USA

    Michelle T. Pelle &  Victoria P. Werth

  2. Department of Dermatology, Veterans Administration Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Victoria P. Werth

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  1. Michelle T. Pelle
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  2. Victoria P. Werth
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Correspondence to Victoria P. Werth.

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Pelle, M.T., Werth, V.P. Thalidomide in Cutaneous Lupus Erythematosus. Am J Clin Dermatol 4, 379–387 (2003). https://doi.org/10.2165/00128071-200304060-00002

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