Author: Vanessa Ngan, Staff Writer, 2002.
Thalidomide was first used in the late 1950's all over the world as a wonder drug that would help stop nausea and insomnia in pregnant women. Soon after, it was discovered to be the cause of severe birth defects in the offspring of women who had taken the drug. Thalidomide was immediately withdrawn worldwide but investigators have continued to see its potential in the treatment of other conditions.
Thalidomide is proving to be useful in the treatment of some severe dermatological conditions and is currently approved by the US Food and Drug Administration (FDA) for the treatment of cutaneous manifestations of moderate to severe erythema nodosum leprosum in leprosy. However, its use is strictly monitored and many precautions are taken to ensure its safe and correct use by both prescriber and patient. In New Zealand thalidomide has not been approved for use for any condition, however special application to the Ministry of Health may allow its use in exceptional circumstances.
The mechanism of action of thalidomide in the treatment of dermatological conditions is not yet completely understood. It appears that thalidomide prevents the immune system from overreacting to disease and harming the body by reducing the levels of cytokine tumour necrosis factor-alpha (TNF-alpha), a protein in the body that causes inflammatory reactions.
Thalidomide is currently being used or investigated as a treatment for the following dermatological conditions:
Thalidomide is usually only considered as a treatment in patients with severe disabling conditions where all other treatments have failed.
The most well known side effect of thalidomide is its ability to cross the placenta of pregnant women and cause severe birth defects. With this in mind any use of thalidomide is under strict supervision.
Other side effects include drowsiness, rash and constipation. Peripheral neuropathy that may be irreversible has been reported. Early symptoms of nerve damage include numbness, tingling or pain in the hands, arms, legs and feet. Patients should stop treatment and report these symptoms to their doctor immediately.
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