[Thalidomide therapy for discoid lupus erythematosus]

Discoid lupus erythematosus (DLE) is a chronic form of cutaneous lupus. Thalidomide has been reported as an effective treatment in at least 200 cases of severe DLE. In this article we studied the efficacy and adverse effects of thalidomide in 10 patients with disseminated DLE.

This report presents the retrospective evaluation of 10 patients treated with thalidomide in our department during the period 1996-2005.

All patients treated with thalidomide had been unresponsive to at least two other systemic treatments. The patients were treated with low-dose thalidomide of 50-200 mg per day. The dose was tapered after a clinical remission. All patients had a favorable response within 6 weeks. Of 10 patients 9 had complete regression of lesions. Four patients remain free of disease without maintenance treatment and 5 patients relapsed after cessation of thalidomide. All relapses responded after the reinstitution of the drug. The side effects of thalidomide treatment were mostly transient. The most common adverse effects were sedation and weight gain. Two patients developed peripheral sensory neuropathy resolved with discontinuation of thalidomide. Two patients of premenopausal age reported amenorrhea.

Low-dose thalidomide treatment is an effective treatment option for discoid lupus erythematosus in cases resistant to other treatments. It is essential to be conversant with all the precautions in order to minimize the risks of side effects.