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Asha Shah, MD; Joerg Albrecht, MD; Zuleika Bonilla-Martinez, MD; Joyce Okawa, RN; Mathew Rose, MB; Misha Rosenbach, MD; Victoria P. Werth, MD

Arch Dermatol. 2009;145(3):303-306.

Background  Discoid lupus erythematosus (DLE) is a chronic, disfiguring disease that is characterized by scaly, erythematous, disk-shaped patches and plaques followed by atrophy, scarring, and dyspigmentation. It is refractory to standard therapies in a small population of patients. We investigated the use of lenalidomide, a thalidomide analogue, as a novel alternative therapy in 2 cases of refractory DLE and report our results.

Observations  Two patients with chronic, severe DLE were treated with low-dose lenalidomide. Improvement was noted within 1 month at a dosage of 5 mg/d in one case and was maintained for 10 months before the dosage was doubled to 10 mg/d for 12 months because of a slight worsening of symptoms. Clinical improvement was demonstrated by a sustained reduction in the Cutaneous Lupus Erythematosus Disease Area and Severity Index activity score, with no change in the Cutaneous Lupus Erythematosus Disease Area and Severity Index damage score. Within 5 months, oral prednisone therapy (60 mg/d) was tapered and discontinued; it was restarted at a low dosage (5 mg/d), however, to manage the symptoms of systemic LE. Of note, the patient experienced mild neutropenia after taking 10 mg/d of lenalidomide, which carries a black box warning regarding neutropenia; therefore, the complete blood cell count should be monitored weekly for the first 2 months and then monthly therafter. The second case failed to show clinical improvement, and lenalidomide therapy was discontinued after 6 months.

Conclusions  Lenalidomide therapy is a potential alternative or adjunctive treatment for patients with severe, chronic DLE that is refractory to standard therapies. A larger study is needed to clarify its role in the treatment of DLE and other forms of cutaneous LE.

Author Affiliations: Departments of Dermatology, University of Pennsylvania, Philadelphia (Drs Shah, Albrecht, Bonilla-Martinez, Rosenbach, and Werth, Ms Okawa, and Mr Rose), and Philadelphia Veterans Affairs Hospital (Dr Werth). Dr Shah is now with the Department of Internal Medicine, Emory University, Atlanta, Georgia.

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