Thalidomide and its impact in dermatology

Thalidomide, originally marketed as a sedative, was introduced in West Germany in 1956 and in numerous other countries soon thereafter. In part because it did not impair coordination or respiratory function, the drug rapidly became extremely popular. By 1961, however, there were mounting reports of phocomelia and other severe congenital abnormalities associated with maternal use of thalidomide, and the drug was withdrawn from the market and its availability highly restricted. A few years later, thalidomide would find use in dermatology after it was reported that leprosy patients with erythema nodosum leprosum (ENL) experienced rapid and dramatic improvement after taking the drug as a sedative. Additional data quickly confirmed thalidomide's efficacy in ENL, and today it is the drug of choice in the condition. In subsequent decades, the drug has been successfully tried in treatment of a variety of apparently unrelated dermatologic disorders. Meanwhile, thalidomide has been shown to possess a range of biologic actions, including inhibition of tumor necrosis factor alpha, possibly relevant to its clinical efficacy. Dermatologic disorders in addition to ENL in which thalidomide's effectiveness is well documented include aphthous stomatitis, discoid lupus erythematosus, actinic prurigo, Behçet's disease, and prurigo nodularis. More recently, the drug has been employed in dermatologic conditions associated with HIV infection. When used with safeguards to prevent teratogenicity and the drug's other major adverse effect, peripheral neuropathy, thalidomide may offer a good therapeutic option for many patients in whom other drug therapies have proven inadequate.