Dermatologic and nondermatologic uses of thalidomide.
OBJECTIVE
To review published data on thalidomide, with emphasis on current knowledge about mechanism of action, new and/or potential dermatologic and nondermatologic therapeutic applications, well-known and emerging adverse effects, and current indications for its safe use.


METHODS
Review articles, in vitro research studies, references from retrieved articles, case reports, and clinical trials were identified from a computerized literature search using MEDLINE and OVID (1966-January 2003) and on the Cochrane Clinical Trials Register (January 2003). Information available from meetings' abstract books, Internet, or pharmaceutical companies was also considered.


METHODS
All articles identified as relevant, including those from non-English literature, were considered in an attempt to provide to the reader both the theoretical basis and practical guidelines for thalidomide pharmacotherapy.


RESULTS
Thalidomide has hypnosedative, antiangiogenic, antiinflammatory, and immunomodulatory properties. Moreover, it has been shown to selectively inhibit the production of tumor necrosis factor-alpha and reduce the expression of various integrin receptors on the membrane of leukocytes and other cell types in a dose-dependent fashion. Controlled trials demonstrated the efficacy of thalidomide in a number of diseases, including erythema nodosum leprosum, lupus erythematosus, aphthosis, graft-versus-host disease, prurigo nodularis, and actinic prurigo. Single case reports or studies in small series have also suggested a possible role for thalidomide in numerous other dermatologic and nondermatologic disorders. Possibly severe and sometimes irreversible risks related to the clinical use of thalidomide include teratogenicity and neurotoxicity.


CONCLUSIONS
Although teratogenicity and neurotoxicity are significant adverse effects requiring cautious use, thalidomide is an effective therapeutic modality in a variety of difficult-to-treat disorders and, providing careful selection of patients, should offer an acceptable risk-to-benefit ratio.
Nasca
Maria R
MR
Department of Dermatology, University of Catania, Catania, Italy.
Micali
Giuseppe
G
Cheigh
Nina H
NH
West
Lee E
LE
West
Dennis P
DP
D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007917:Leprostatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D018579:Patient Selection; D011247:Pregnancy; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use*
D020533:Angiogenesis Inhibitors; D019380:Anti-HIV Agents; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D007917:Leprostatic Agents; D013792:Thalidomide