Thalidomide in the treatment of discoid lupus erythematosus (D.L.E.)
Samsoen, M.; Grosshans, E.; Basset, A.
Annales de Dermatologie et de Venereologie 107(6): 515-523
1980
ISSN/ISBN: 0151-9638 PMID: 7425456 Document Number: 157114
Thalidomide, whose efficiency in the treatment of lepra reactions has been established, may be useful in therapy of DLE , especially in cases which proved resistant to chloroquine and derivatives or relapsed soon after effective treatment. Included were 25 cases in an open study. In 2 cases, strong side effects required an immediate interruption of the therapeutical assay and in 5 cases the treatment failed but was well tolerated. In 10 cases, the lesions healed: the recovery of a healthy skin lasted after cessation of the drug in 6 cases; the lesions relapsed some weeks later in 4 cases. In 5 cases, the lesions improved significantly but needed maintenance therapy and in 3 patients whose lesions improved the side effects led to definitive renunciation. The side effects are frequent sleepiness, dizziness, constipation, dry mouth and rough and scaly skin, but these disappear in a few days after therapy is discontinued. The daily schedule recommended is 100-200 mg until an optimal result is reached (2-4 wk), then determination of an individual maintenance dose (usually 25-100 mg) according to the efficiency and the tolerance of the drug. On account of its teratogenicity, thalidomide can only be used in fecund female patients if contraceptive methods are simultaneously applied. Thalidomide can be recommended in all cases of DLE where antimalarial drugs, topical steroids and sunscreens prove ineffective or contraindicated. In long-term therapy the lesions become dependent on a low daily dose of thalidomide: the hypothetical occurrence of delayed or irreversible side effects is questioned. The effectiveness of thalidomide for other sun-sensitive (polymorphic light eruption) or hyperergic (aphthosis, panniculitis) skin diseases has been established. So far no life-threatening or cumulative side effects have been noticed.