Thalidomide for chronic sarcoidosis.
OBJECTIVE
Thalidomide therapy has been shown to modify granulomatous diseases, such as tuberculosis and leprosy. Lupus pernio is a skin manifestation of sarcoidosis that does not remit spontaneously, and was used as a marker of efficacy of thalidomide for sarcoidosis.


METHODS
An open-label, dose-escalation trial of thalidomide.


METHODS
Patients were seen at one of four specialized sarcoidosis clinics in the United States.


METHODS
Fifteen patients with lupus pernio and other manifestations of sarcoidosis unresponsive to prior therapy were enrolled.


METHODS
Skin lesions were assessed with visual examination by the treating physician, and photographic evaluation by a blinded panel of physicians reviewing photographs of the lesions before and after therapy.


RESULTS
Fourteen patients completed 4 months of therapy. All patients experienced some improvement in their skin lesions subjectively, and 10 of 12 evaluable patients showed improvement using photograph scoring. Five patients were better after 1 month (treated with 50 mg/d of thalidomide), seven more patients improved after 2 months (treated with 100 mg/d of thalidomide in the second month), and two patients required an additional month of 200 mg of thalidomide to achieve a response. Patients reported increased somnolence (n = 9), numbness (n = 7), dizziness (n = 2), constipation (n = 6), rash (n = 1), and increasing shortness of breath (n = 1). One patient discontinued therapy because of new-onset dyspnea, due to probably unrelated new-onset congestive heart failure.


CONCLUSIONS
Thalidomide was an effective form of treatment for chronic cutaneous sarcoidosis. The drug was well tolerated and may be a useful alternative to systemic corticosteroids.
Baughman
Robert P
RP
Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA. Bob.Baughman@uc.edu
Judson
Marc A
MA
Teirstein
Alvin S
AS
Moller
David R
DR
Lower
Elyse E
EE
D000328:Adult; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010781:Photography; D012507:Sarcoidosis / Q000188:drug therapy* / Q000473:pathology; D012871:Skin Diseases / Q000188:drug therapy* / Q000473:pathology; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
D007166:Immunosuppressive Agents; D013792:Thalidomide