Ask the Experts - Thalidomide for Discoid Lupus
Does thalidomide have a role in the treatment of resistant cases of discoid lupus? If so, what is its appropriate dosing and monitoring?

Ahmed El-Rafie, MB, BCh, MSC, MRCP

Thalidomide has been used as an inhibitor of tumor necrosis factor (TNF)-alpha, albeit a weak one, and has been advocated for the treatment of rheumatoid arthritis, lupus skin disease (including discoid lupus erythematosus), and vasculitic skin diseases in which it is thought that the TNF effects on vascular endothelium, intercellular adhesion molecule-1 expression, and keratinocytes mediate manifestations of disease. The commonly used dose is 100 mg/day (range, 25-200 mg/day); the dose may be adjusted downward once cutaneous improvement has been realized. The patient should be monitored closely for adverse effects (eg, drowsiness, vertigo, neuropathy/paraesthesia, constipation, weight gain) and teratogenic precautions must be used (double contraceptive measures, frequent beta-human chorionic gonadotropin screens) in female patients of child-bearing age.