Tratamiento del lupus cutáneo con talidomida

Thalidomide, a glutamic acid derivative, has been used successfully in a variety of chronic refractory inflammatory dermatological conditions with underlying autoimmune or infectious pathogenesis. This drug was first used in the treatment of systemic lupus erythematosus (SLE) in 1975. Since then, there has been renewed interest and increased use of this drug, with a reported effectiveness of up to 80-90%. First line therapy has traditionally been antimalarial agents and/or topical steroids, together with sun protection. For refractory cases, there is no consensus algorithm and a trial and error approach using multiple systemic agents has yielded a variable response. The lack of effective treatment, together with the chronic and relapsing course of this disease, contribute to delaying resolution of the inflammatory lesions and to consequent scarring. Although the mechanism of action of thalidomide is not completely known, its efficacy seems to be mediated by its immunomodulatory and antiinflamatory properties. In vitro studies have demonstrated that thalidomide inhibits neutrophil chemotaxis and phagocytosis, angiogenesis, and the production of tumor necrosis factor alfa and that it interacts with the T-helper response and the regulation of transcription factor nuclear kB. Despite its proven effectiveness, the use of thalidomide is still limited by its notorious adverse effects such as teratogenicity, neurotoxicity and thrombosis.