title: Lenalidomide for the treatment of resistant discoid lupus erythematosus.
abstract: BACKGROUND
  Discoid lupus erythematosus (DLE) is a chronic, disfiguring disease that is characterized by scaly, erythematous, disk-shaped patches and plaques followed by atrophy, scarring, and dyspigmentation. It is refractory to standard therapies in a small population of patients. We investigated the use of lenalidomide, a thalidomide analogue, as a novel alternative therapy in 2 cases of refractory DLE and report our results.
  
  
  METHODS
  Two patients with chronic, severe DLE were treated with low-dose lenalidomide. Improvement was noted within 1 month at a dosage of 5 mg/d in one case and was maintained for 10 months before the dosage was doubled to 10 mg/d for 12 months because of a slight worsening of symptoms. Clinical improvement was demonstrated by a sustained reduction in the Cutaneous Lupus Erythematosus Disease Area and Severity Index activity score, with no change in the Cutaneous Lupus Erythematosus Disease Area and Severity Index damage score. Within 5 months, oral prednisone therapy (60 mg/d) was tapered and discontinued; it was restarted at a low dosage (5 mg/d), however, to manage the symptoms of systemic LE. Of note, the patient experienced mild neutropenia after taking 10 mg/d of lenalidomide, which carries a black box warning regarding neutropenia; therefore, the complete blood cell count should be monitored weekly for the first 2 months and then monthly thereafter. The second case failed to show clinical improvement, and lenalidomide therapy was discontinued after 6 months.
  
  
  CONCLUSIONS
  Lenalidomide therapy is a potential alternative or adjunctive treatment for patients with severe, chronic DLE that is refractory to standard therapies. A larger study is needed to clarify its role in the treatment of DLE and other forms of cutaneous LE.
authors.affiliation: Department of Dermatology, University of Pennsylvania, 3600 Spruce St, Philadelphia, PA 19104, USA.
authors.forename: Asha
authors.initials: A
authors.lastname: Shah
authors.forename: Joerg
authors.initials: J
authors.lastname: Albrecht
authors.forename: Zuleika
authors.initials: Z
authors.lastname: Bonilla-Martinez
authors.forename: Joyce
authors.initials: J
authors.lastname: Okawa
authors.forename: Mathew
authors.initials: M
authors.lastname: Rose
authors.forename: Misha
authors.initials: M
authors.lastname: Rosenbach
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008179:Lupus Erythematosus, Discoid / Q000188:drug therapy* / Q000473:pathology; D009503:Neutropenia / Q000139:chemically induced; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D013792:Thalidomide; D000077269:Lenalidomide