title: Review of thalidomide use in the pediatric population.
abstract: Thalidomide is resurging in the management of adult rheumatologic skin conditions, especially lupus erythematosus. Although use in pediatric patients is reported since the 1990s, there are no systematic reviews describing treatment in children. Thalidomide has immunomodulatory and anti-tumor necrosis factor-α effects as well as antiangiogenic properties, making it useful for a broad spectrum of inflammatory disorders. Thalidomide is second-line treatment for aphthous stomatitis and chronic graft-versus-host disease in children and has been prescribed for many other conditions including actinic prurigo and epidermolysis bullosa pruriginosa. Systemic lupus erythematosus may be less responsive to thalidomide in children than adults. Peripheral neuropathy is observed in both idiosyncratic and dose-dependent relationships; children older than 12 years may be more susceptible to developing this adverse effect than younger patients. There are rare reports of thrombotic complications in children treated for nonmalignant indications. We review the mechanism of action and propose that thalidomide is an alternative treatment for patients who fail or have contraindications to anti-tumor necrosis factor-α biologics.
authors.affiliation: Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: catherine_yang@brown.edu.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Yang
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Changhyun
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Antaya
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000293:Adolescent; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000209:etiology; D004363:Drug Utilization; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D009369:Neoplasms / Q000188:drug therapy; D012871:Skin Diseases / Q000188:drug therapy; D013281:Stomatitis, Aphthous / Q000188:drug therapy; D013792:Thalidomide / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D013792:Thalidomide
keywords: Behçet disease; aphthous ulcers; epidermolysis bullosa pruriginosa; graft-versus-host disease; medical dermatology; pediatrics; peripheral neuropathy; pharmacology; thalidomide