Erythroderma due to Thalidomide: Report of Two Cases

Abstract

Cutaneous reactions to thalidomide therapy are reported infrequently. We report two new cases. Both patients suffered from chronic renal insufficiency and were on thalidomide therapy because of prurigo nodularis. The cutaneous reaction consisted of a severe erythematous rash progressing to erythroderma, associated with peripheral eosinophilia. In both cases rapid resolution occurred after withdrawal of thalidomide. We emphasize the possibility of a severe cutaneous hypersensitivity reaction due to thalidomide and speculate about the role played by the renal insufficiency present in both cases.

Treatment of cutaneous sarcoidosis with thalidomide

“…30 More infrequent effects are neutropenia, hypothyroidism, 31,32 and secondary amenorrhea. 33 Some cutaneous side effects have been reported, eg, pruritus, facial edema, palmar erythema, 32 rash, 34 drug rash with eosinophilia and systemic symptoms, 35 and oral lichenoid lesions. 36 How thalidomide acts will remain uncertain as long as the pathophysiology of sarcoidosis is unclear.…”

Prurigo nodularis of Hyde: an update

“…Bielsa et al . 86 reported erythroderma during the use of thalidomide in two subjects with chronic renal insufficiency. The authors emphasized the possibility of a severe cutaneous hypersensitivity reaction due to the drug and speculate about the role performed by the renal insufficiency present in both cases.…”

Thalidomide-Induced Morbilliform Rash: Diagnosis and Continuation of Therapy, Premedicated with Methylprednisolone

“…Singhal et al [4] saw an increase in CDR from 16% in patients treated with 200 mg/day to 26% in patients treated with 600 mg/day. In addition to morbilliform rashes there are rare case reports of patients with thalidomide-induced erythroderma, exfoliative dermatitis, toxic pustuloderma, purpura, vasculitis, facial edema, red palms, alopecia, pruritus, xerosis, xerostomia and burning sensations [1,2,[5][6][7][8][9][10][11]. Urticaria and bullous eruptions are reported by Sheskin [10] in 3 and 5%, respectively, of his patients with leprosy treated with thalidomide.…”