Low-dose thalidomide is an effective second-line treatment in cutaneous lupus erythematosus

BACKGROUND: The use of thalidomide in inflammatory cutaneous disorders has increased over recent years. Its use in cutaneous lupus erythematosus is no w well documented, although most groups favour high-dose regimes (200 mg tw ice daily), where side effects are common and may limit drug use. METHODS: A total of 27 patients with cutaneous lupus erythematosus were tre ated using a low-dose thalidomide regime (starting dose of 50 mg twice dail y). RESULTS: Results have been favourable, with a good response or total diseas e remission seen in 66% of patients. The prevalence of side effects was low . Nausea, sedation or tremor were seen in 8 patients but these were tolerab le in all but four patients. No patient had symptoms of peripheral neuropat hy. Owing to its teratogenicity, adequate counselling must be given to fema le patients of childbearing age. CONCLUSION: On the basis of these findings, low-dose thalidomide is advocat ed as a second-line treatment in cutaneous lupus erythematosus.