Thalidomide, originally marketed as a sedative, wets introduced in West Ger
many in 1956 and in numerous other countries soon thereafter, In part becau
se it did not impair coordination or respiratory function, the drug rapidly
became extremely popular. By 1961, however, there were mounting reports of
phocomelia and other severe congenital abnormalities associated with mater
nal use of thalidomide, and the drug was withdrawn from the market and ifs
availability highly restricted, A few years later, thalidomide would find u
se in dermatology after it was reported that leprosy patients with erythema
nodosum leprosum (ENL) experienced rapid and dramatic improvement otter ta
king the drug as a sedative. Additional data quickly con firmed thalidomide
's efficacy in ENL, and today it is the drug of choice in the condition, In
subsequent decades, the drug has been successfully tried in treatment of a
variety of apparently unrelated dermatologic disorders. Meanwhile, thalido
mide has been shown to possess a range of biologic actions, including inhib
ition of tumor necrosis factor alpha, possibly relevant to its clinical eff
icacy. Dermatologic disorders in addition to ENL in which thalidomide's eff
ectiveness is well documented include aphthous stomatitis, discoid lupus er
ythematosus, actinic prurigo, Behcet's disease, and prurigo nodularis. Mote
recently, the drug hers been employed in dermatologic conditions associate
d with HIV infection. When used with safeguards to prevent teratogenicity a
nd the drug's other major adverse effect, peripheral neuropathy, thalidomid
e may offer a good therapeutic option for many patients in whom other drug
therapies have proven inadequate. Copyright (C) 1998 by W.B. Saunders Compa
ny.