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A case series of 48 patients treated with thalidomide.

INTRODUCTION
Thalidomide is approved by the Food and Drug Administration (FDA) for erythema nodosum leprosum, but has been used in many other dermatological conditions that are refractory to standard therapy.


METHODS
The medical records of 48 patients treated with thalidomide at Baylor College of Medicine (Houston, TX) were retrospectively reviewed to determine the conditions treated with thalidomide, dosing, efficacy, treatment duration, side effects, adverse events, and reason for discontinuing therapy.


RESULTS
Forty-eight patients (men = 18, women = 30) with a mean age of 49.6 years (range: 20-79) were included in this study. Patients were treated for prurigo nodularis, discoid lupus erythematosus, tumid lupus erythematosus, subacute cutaneous lupus erythematosus, systemic lupus erythematosus, lichen planus, lichen planopilaris, cutaneous sarcoidosis, and prurigo nodularis. All conditions were refractory to standard therapy. Patients were treated for a mean of 7.5 months (range: 3 days to 70 months). In most of the disorders, a majority of patients experienced clinical improvement. The most common reason for discontinuation of therapy was side effects, the most frequent being peripheral neuropathy.


LIMITATIONS
This study was limited by being retrospective in nature.


CONCLUSION
Thalidomide effectively treats some dermatologic conditions that are refractory to standard medications. There are inconveniences associated with obtaining the medication and it is expensive. Physicians must be vigilant for possible side effects, especially peripheral neuropathy.