Thalidomide

Thalidomide has been successful in the treatment of several dermatologic conditions unresponsive to other agents. Further experience may lead to a better understanding of its mechanism of action in these various diseases. Thalidomide should be considered an extremely valuable therapeutic option in selected patients when the benefits clearly outweigh the risks of teratogenicity and peripheral neuropathy.     

Thalidomide Therapy

Abstract: In an open trial, 35 patients suffering from a variety of dermatologic conditions were treated with thalid-omide. The drug was shown to be a valuable addition to the therapeutic armamentarium; however, the occurrence of a peripheral neuropathy will limit its use just as its teratogenic side effects have done for many years.     

沙利度胺(反应停)在皮肤科的应用

沙利度胺(反应停)最早应用于皮肤科是1965年以色列专家将其作为镇静药用于治疗麻风结节性红斑(ENL)患者。此后,其在抗炎、免疫调节和抗血管生成等方面作用不断得到证实,除了肿瘤及关节炎症外,它在治疗某些顽固性皮肤病,特别是皮肤血管炎等疾病中发挥了显著作用。目前认为反应停可能是一个存在巨大潜力的药物。     

Thalidomide and its dermatologic uses

Thalidomide is a beneficial agent for treating a variety of refractory dermatologic disorders including erythema nodosom leprosum, lupus erythematosus, prurigo nodularis, actinic prurigo, pyoderma gangrenosum and aphthous stomatitis. Two thalidomide analogues, lenalidomide and CC-4047, are considerably more potent with decreased side effects when compared to thalidomide. They are currently undergoing trials and show promise, as they have increased immunomodulatory and anti-angiogenic activity. This category of medication and its use will be reviewed.     

Thalidomide in dermatology

Thalidomide is an effective agent to treat over 25 seemingly unrelated dermatological conditions that have an inflammatory or autoimmune basis. The main side-effects of teratogenesis and peripheral neuropathy limit its use. Currently, in Australia no assurance is given as to the quality, safety and efficacy of thalidomide. The use of thalidomide for toxic epidermal necrolysis can lead to an increase in mortality, and its use as a prophylactic agent for the prevention of chronic graft-versus-host disease following bone marrow transplantation has raised more speculations as to the safety of this notorious drug. A review of the therapeutic indications for thalidomide in dermatology as well as the mechanisms of action and side-effects of this drug are presented. The current suggested guidelines for its use in clinical practice in Australia are discussed.     

Thalidomide in actinic prurigo

Fourteen patíents sufferíng from actíníc prurígo were treated with thalidomide. Eleven patients showed lasting improvement on the drug and three of these remained symptom-free after discontinuing therapy. No major side-effects were observed. Thalidomide is an effective drug in the treatment of actinic prurigo but it must be used with adequate contraception in women of child-bearing age.     

羟氯喹、氨苯砜、沙利度胺在皮肤科的应用

对慢性反复发作性皮肤病有效的药物较少,一些特殊的皮肤病或经过系统治疗而疗效不佳者,有必要寻找有特殊疗效的药物。本文主要对羟氯喹、氨苯砜和沙利度胺(反应停)在皮肤科的新用途、作用机制、代谢及不良反应等做一综述。     

Thalidomide treatment of prurigo nodularis

Four patients with classic recalcitrant prurigo nodularis had symptomatic and physical responses to thalidomide with remissions. Three of the four patients had increased IgE levels that decreased during therapy. In two patients, short-term treatment (2 to 3 months) was not sufficient to produce remission, but retreatment was effective. Two patients had long-term remission with more than 6 months of treatment. No significant side effects occurred.