title: Thalidomide in the treatment of cutaneous lupus refractory to conventional therapy.
abstract: OBJECTIVE
  We describe a prospective treatment study of thalidomide in a series of 22 patients with cutaneous lupus refractory to other treatments.
  
  
  METHODS
  From 1992 to 1998, 22 patients with cutaneous lupus (9 with discoid lupus erythematosus, 7 with subacute cutaneous lupus, 4 with profundus lupus, 2 with nonspecific rash) were treated with thalidomide. Initial treatment was started at 100 mg daily. If the cutaneous lesions vanished, the dose was lowered to 50-25 mg daily as a maintenance therapy and it was considered a complete remission. If the lesions improved but remained, this was considered a partial response and treatment was continued until the lesions were not further modified. Periodically, adverse effects were evaluated.
  
  
  RESULTS
  Three patients discontinued treatment because of side effects such as vertigo, persistent drowsiness, or paresthesia. Rash improved in 16/19 patients (84%). Complete remission occurred in 12/16 (75%). In 9 (65%) the rash resolved, but recurred 4-16 weeks after withdrawal of thalidomide; when it was used again, they improved. Partial response was achieved in 4/16 (25%) patients. No response occurred in 3/19 (16%). Many patients noted improvement within 2 weeks after starting thalidomide and maximum benefit was achieved within 3 months. Five of the 14 women had amenorrhea during the treatment with thalidomide.
  
  
  CONCLUSIONS
  Thalidomide is effective in the treatment of cutaneous lupus refractory to other treatments. However, only some patients had a remission; the remainder relapsed when treatment was withdrawn, or required low doses of thalidomide to preserve inactive lesions. Amenorrhea was observed as a new secondary effect of thalidomide.
authors.affiliation: Internal Medicine Department, Vall d'Hebron Hospital, Autónoma University of Barcelona, Spain. ordiros@hg.vhebron.es
authors.forename: J
authors.initials: J
authors.lastname: Ordi-Ros
authors.forename: F
authors.initials: F
authors.lastname: Cortés
authors.forename: E
authors.initials: E
authors.lastname: Cucurull
authors.forename: M
authors.initials: M
authors.lastname: Mauri
authors.forename: S
authors.initials: S
authors.lastname: Buján
authors.forename: M
authors.initials: M
authors.lastname: Vilardell
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced; D005076:Exanthema / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008179:Lupus Erythematosus, Discoid / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013792:Thalidomide