Successful long-term thalidomide therapy for discoid lupus erythematosus-lichen planus overlap syndrome

Lisa Zhang,Sonoa Au,Iris K Aronson

doi:10.5070/d32010024267

Abstract

Although thalidomide is a U.S. Food and Drug Admistration (FDA) approved medication for erythema nodosum leprosum and multiple myeloma, it has many off-label uses, including for discoid lupus erythematosus (DLE), Behçet's disease, apththous ulcers in HIV patients, and prurigo nodularis. Herein, we present a patient with an overlap of discoid lupus erythematosus and lichen planus who was successfully treated with thalidomide for over 19 years without significant side effects. We propose that some of the most common side effects, including peripheral neuropathy, numbness, parasthesias, sedation, and constipation, can be avoided at lower doses, typically less than 100mg/day.

Highlights

Since the devastating connection between thalidomide and phocomelia was recognized in the 1960s, thalidomide’s use has been severely limited
Thalidomide was used for a period of 19 years to treat a rare overlap syndrome of discoid lupus erythematosus (DLE) and lichen planus (LP) exhibiting erosions of palms and soles refractory to any other treatment apart from high dose systemic corticosteroids
A 27-year-old woman presented to our dermatology clinic for treatment of a rare overlap syndrome of DLE and LP, originally diagnosed at age 17 after clinical evaluation and histopathologic confirmation

Summary

Introduction

Since the devastating connection between thalidomide and phocomelia was recognized in the 1960s, thalidomide’s use has been severely limited. Many off-label uses include discoid lupus erythematosus (DLE), Behçet’s disease, apththous ulcers in HIV patients, and prurigo nodularis [1], currently, the only FDA approved indications for thalidomide are erythema nodosum leprosum (ENL) and multiple myeloma in conjunction with dexamethasone [2]. Thalidomide was used for a period of 19 years to treat a rare overlap syndrome of DLE and lichen planus (LP) exhibiting erosions of palms and soles refractory to any other treatment apart from high dose systemic corticosteroids. To the authors’ knowledge, this patient marks the longest documented course of thalidomide usage for DLE and LP overlap without significant side effects

Case synopsis

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Discussion