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Multiple Myeloma Patients Treated With Thalidomide Can Experience Dermatologic Side Effects

Dermatologic side effects of thalidomide can be quite severe in some newly diagnosed patients with multiple myeloma, especially in conjunction with dexamethasone, say researchers in the United States.

The prevalence of these side effects, which are minor in most patients, are higher than previously reported, they suggest.

Further studies are needed "to verify the extent of the interaction between thalidomide and dexamethasone" in such patients, according to. V. C. Hall and clinicians at the Department of Dermatology, Mayo Clinic, Jacksonville, and the Department of Dermatology and Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota.

While the teratogenic and neurologic side effects of thalidomide, approved by the FDA in 1998 for treating erythema nodosum leprosum, are well known, its dermatologic side effects are yet to be defined. Eighty seven patients with multiple myeloma were enrolled into this open-label clinical trial to examine these side effects.

Records of all subjects were reviewed; 50 were treated with thalidomide alone and 57 with thalidomide and dexamethasone. Records were made of the frequency, severity, type and time of onset of all skin eruptions temporally related to the therapy.

In subjects taking thalidomide alone, 46% were found to have minor to moderate skin eruptions compared with 43% of those taking thalidomide and dexamethasone. Included were seborrheic, morbilliform, maculopapular or nonspecific dermatitis.

Three of those given thalidomide and dexamethasone developed severe skin reaction requiring hospitalisation and withdrawal of thalidomide. These reactions included exfoliative erythroderma, erythema multiforme and toxic epidermal necrolysis.
J Am Acad Dermatol 2003 Apr;48(4):548-52. "Dermatologic side effects of thalidomide in patients with multiple myeloma"

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