Low-dose thalidomide is an effective second-line treatment in cutaneous lupus erythematosus

The use of thalidomide in inflammatory cutaneous disorders has increased over recent years. Its use in cutaneous lupus erythematosus is now well documented, although most groups favour high-dose regimes (200 mg twice daily), where side effects are common and may limit drug use.

A total of 27 patients with cutaneous lupus erythematosus were treated using a low-dose thalidomide regime (starting dose of 50 mg twice daily).

Results have been favourable, with a good response or total disease remission seen in 66% of patients. The prevalence of side effects was low. Nausea, sedation or tremor were seen in 8 patients but these were tolerable in all but four patients. No patient had symptoms of peripheral neuropathy. Owing to its teratogenicity, adequate counselling must be given to female patients of child-bearing age.

On the basis of these findings, low-dose thalidomide is advocated as a second-line treatment in cutaneous lupus erythematosus.