Rediscovery of thalidomide. Successful treatment of discoid lupus erythematosus

Thalidomide,an oral drug introduced in Germany in 1953 as a mild sedative, was withdrawn from the world market when its teratogenic effect was discove red some years later. It has since been selectively reintroduced to treat a variety of autoimmune or inflammatory diseases such as erythema nodosum le prosum, prurigo nodularis, graft-versus-host disease, and discoid lupus ery thematosus (DLE). We report on three patients with long-standing,severe DLE showing no response to systemic first-, second- and third-line treatments. After four weeks of therapy with thalidomide the skin lesions had improved dramatically and after three to six months all three patients responded wi th an almost complete remission. The side effects of thalidomide, especiall y somnolence and paresthesias, were minor and well tolerated by the patient s. Our data confirm that thalidomide provides one of the most useful therap eutic alternatives for chronic refractory DLE, despite the risks of teratog enicity and polyneuropathy.