Thalidomide therapy for cutaneous lupus erythematosus: historical and practical considerations

Abstract

Connective tissue diseases are notoriously difficult to treat and the cutaneous manifestations of lupus erythematosus (LE) can be severe, leading to significant and progressive disfigurement. Fortunately several modalities exist for the treatment of this condition. However, oftentimes patients manifest severe disease and are refractory to conventional treatment. Second‐ and third‐line agents used to treat cutaneous LE (CLE) can also exhibit many intolerable side effects. Thalidomide, a drug with a notorious past, has been found to be efficacious in the treatment of most of these patients. Response can be dramatic and patients are often maintained on thalidomide as a monotherapy. We review thalidomide's past, with a focus on its use in the treatment of CLE. We also discuss the practical issues involved in safely administering this drug, using three case histories. In conclusion, thalidomide is very effective in the treatment of CLE, however, prolonged use is often needed to maintain long‐term remission. Properly used, thalidomide is very safe, with minimal and mild side effects. However, proper implementation and monitoring is imperative to guard against known serious side effects of teratogenicity and neuropathy.