Thalidomide: A Boon to Dermatology? Current Indications and Concerns

Abstract

Thalidomide is a drug with a complex past. Initially marketed as a sedative and anti‐emetic for use in pregnancy, thalidomide was linked to embryologic defects and was withdrawn from the market. However, it has since made a comeback for the U.S. FDA‐approved use in the treatment of erythema nodosum leprosum (ENL).This presentation analyses the publications made between 2000 and 2009 obtained by searching the pubmed database using key words “thalidomide and dermatology and uses”.Thalidomide's effect on immune system include; suppression of the production of IgM antibodies inhibition of tumour necrosis factor‐α, inhibition of IL‐8, IL‐12, enhancement of IL‐2, IL‐4, IL‐5, inhibition of cytokine‐induced NF‐κB gene expression and decrease of B lymphocytes in the spleen.Currently, thalidomide is known to be effective in unresponsive dermatological conditions such as actinic prurigo, adult Langerhans cell histiocytosis, aphthous stomatitis, Behçet's syndrome, graft‐versus‐host disease, cutaneous sarcoidosis, erythema multiforme, Kaposi sarcoma, lichen planus, lupus erythematosus, melanoma, prurigo nodularis, pyoderma, gangrenosum and uraemic pruritus.While there are undoubted benefits with use of thalidomide in the field of dermatology, the more serious adverse drug reactions such as teratogenecity, peripheral neuropathy and the relatively uncommon side‐effects like neutropenia, mood changes, thromboembolic complications, such as deep vein thrombosis and pulmonary embolism must be watched for. As most of the dermatological conditions require a long term administration of thalidomide, these adverse drug reactions must be thoroughly screened for. Further studies on the exact mechanism of action of thalidomide may help us in identifying the potential therapeutic benefits of this drug even further.