Thalidomide: an experience in therapeutic outcome and adverse reactions.
BACKGROUND
The US FDA-approved thalidomide for the treatment of chronic recurrent/severe erythema nodosum leprosum. Thalidomide is also useful in many other inflammatory dermatological conditions where patients have exhausted other treatment options.


METHODS
The beneficial and adverse clinical effects of thalidomide were studied in 25 patients suffering from different inflammatory dermatological conditions that were poorly controlled with conventional therapies.


RESULTS
Thalidomide was found to be effective in various inflammatory dermatological diseases other than chronic recurrent erythema nodosum leprosum such as Behçet's disease, disseminated and hypertrophic discoid lupus erythematosus, erosive lichen planus, discoid lupus erythematosus-lichen planus overlap, recurrent aphthous stomatitis and prurigo nodularis. Deep vein thrombosis due to thalidomide occurred in 20% of these patients and appears to be a significant side effect.


CONCLUSIONS
Thalidomide appears promising in a number of inflammatory dermatological conditions and will probably find new usages in future. The treating physicians need to be wary of the thrombo-embolic complications due to thalidomide especially when glucocorticoids or other chemotherapeutic agents such as doxorubicin, gemcitabine, 5-fluorouracil or dexamethasone-cyclophosphamide pulse therapy are being used concomitantly, and in patients of metastatic renal carcinoma, myelodysplastic syndrome or multiple myeloma receiving thalidomide/chemotherapy. Antiphospholipid or anticardiolipin antibodies appear to be other possible risk factors for this complication.
Sharma
Nand L
NL
Department of Dermatology, Venereology & Leprosy, Indira Gandhi Medical College, Shimla, India. nandlals@hotmail.com
Sharma
Vikas C
VC
Mahajan
Vikram K
VK
Shanker
Vinay
V
Ranjan
Nitin
N
Gupta
Mudita
M
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001528:Behcet Syndrome / Q000188:drug therapy; D004893:Erythema Nodosum / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications; D008010:Lichen Planus / Q000188:drug therapy; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011536:Prurigo / Q000188:drug therapy; D012871:Skin Diseases / Q000188:drug therapy*; D013281:Stomatitis, Aphthous / Q000188:drug therapy; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced*
D000893:Anti-Inflammatory Agents; D013792:Thalidomide