Use of thalidomide in dermatological indications

The resurgence of interest in thalidomide in the last decade has been remar kable. Thalidomide has established its own niche market particularly for th e dermatological manifestations associated with HIV, Behcet's disease, graf t-versus-host disease and systemic lupus erythematosus, To a large extent t his has resulted from initial empirical uncontrolled studies in conditions resistant to other drug therapies. Appropriate trials are now being publish ed for most of the prevalent indications. Thalidomide produces partial inhi bition of tumour necrosis factor-alpha production in vivo but recent data r eveals that it can also act as a co-stimulatory molecule for T cell activat ion in vitro, resulting in increased production of interleukin-2 and interf eron-gamma. Hence in addition to monocyte inhibitory activity, thalidomide can exert a co-stimulatory or adjuvant-like effect on T cell responses, The unraveling of the molecular basis of thalidomide's therapeutic effects wou ld suggest that an expansion of the use of thalidomide and its analogues in other conditions is highly likely. It remains imperative, however, that ph ysicians using this fascinating drug are familiar with its risks and advers e effects.