London SE0 6EH SUMMARY

We review the e.cacy \ tolerability and safety of low!dose thalidomide in the treatment of refractory dis_guring rash in 05 patients with cutaneous manifestations of lupus [ Rashes \ which included discoid lupus erythematosus "DLE# \ subacute cutaneous lupus "SCLE# \ photosensitive malar rash and non!speci_c chronic erythema \ were diagnosed on clinical grounds \ supported by skin biopsy in 00:05 patients [ Using starting doses of 49099 mg:day \ 6:05 "33) # patients gained complete or near!complete remission of skin disease and 5:05 "26) # partial remission [ Three out of 05 patients failed to respond [ Maximum bene_t was achieved within 05 weeks in all patients [ Doses of 1449 mg:day were e}ective in maintaining response [ Rapid relapse occurred in 5:7 "64) # 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 e}ective in the treatment of severe skin manifestations of lupus refractory to other treatment and can be used safely in specialist rheumatological practice[ KEY WORDS] Thalidomide \ Subacute cutaneous lupus \ Discoid lupus erythematosus \ Systemic lupus erythematosus \ Treatment\ Adverse e}ects \ Neuropathy[ THE serious adverse e}ects of thalidomide \ namely teratogenicity "phocomelia \ mid!line defects \ microph! thalmia # 0 and peripheral neuropathy 1 \ are wel