The British Journal of Rheumatology, Vol 36, 353-359, Copyright © 1997 by British Society for Rheumatology
RJ Stevens, C Andujar, CJ Edwards, PR Ames, AR Barwick, MA Khamashta and GR Hughes
We review the efficacy, tolerability and safety of low-dose thalidomide in
the treatment of refractory disfiguring rash in 16 patients with cutaneous
manifestations of lupus. Rashes, which included discoid lupus erythematosus
(DLE), subacute cutaneous lupus (SCLE), photosensitive malar rash and
non-specific chronic erythema, were diagnosed on clinical grounds,
supported by skin biopsy in 11/16 patients. Using starting doses of 50-100
mg/day, 7/16 (44%) patients gained complete or near-complete remission of
skin disease and 6/16 (37%) partial remission. Three out of 16 patients
failed to respond. Maximum benefit was achieved within 16 weeks in all
patients. Doses of 25-50 mg/day were effective in maintaining response.
Rapid relapse occurred in 6/8 (75%) patients following drug withdrawal, but
the response to thalidomide in those requiring repeat courses appeared to
be maintained. There was no detectable improvement in systemic disease. One
patient developed symptoms of mild peripheral neuropathy which resolved on
drug withdrawal. Our experience suggests that thalidomide is effective in
the treatment of severe skin manifestations of lupus refractory to other
treatment and can be used safely in specialist rheumatological practice.
ORIGINAL PAPERS
Thalidomide in the treatment of the cutaneous manifestations of lupus erythematosus: experience in sixteen consecutive patients
Department of Rheumatology, Rayne Institute, St Thomas Hospital, London.
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