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Journal of the American Academy of Dermatology
Volume 74, n° 2
pages 363-369 (février 2016)
Doi : 10.1016/j.jaad.2015.09.039
accepted : 16 September 2015

Thalidomide for the treatment of chronic refractory pruritus

Divya Sharma, BS a, Shawn G. Kwatra, MD b,
a Rutgers University, New Jersey Medical School, Newark, New Jersey 
b Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland 

Reprint requests: Shawn G. Kwatra, MD, Cancer Research Building II, Johns Hopkins University School of Medicine, 1550 Orleans St, Baltimore, MD 21231.

Pruritus is a common and often times difficult to treat symptom in many dermatologic and systemic diseases. For pruritus with an inflammatory or autoimmune origin, therapies such as topical corticosteroids and antihistamines are often initiated. However, in the case that these and additional systemic therapies are ineffective, thalidomide, an immunomodulator and neuromodulator, may be a useful alternative treatment. Considerable relief of chronic pruritus has been demonstrated with thalidomide in case reports, case series, and controlled trials. Double-blind controlled studies demonstrated thalidomide's efficacy as an antipruritic agent in patients with uremic pruritus, primary biliary cirrhosis, and prurigo nodularis. In case reports, case series, and open-label trials, thalidomide significantly reduced pruritus associated with conditions such as actinic prurigo and paraneoplastic pruritus. Because of variations in study design and evaluation of antipruritic effect, it is difficult to fully understand thalidomide's role based on the evidence described to date in the medical literature. In this review, we provide an overview of the reported findings and evaluate thalidomide's utility in managing refractory pruritus in the context of its adverse risk profile. We propose that thalidomide can be an alternative or combination antipruritic treatment for patients who do not obtain enough relief from conservative therapy.

The full text of this article is available in PDF format.

Key words : actinic prurigo, itch, prurigo nodularis, pruritus, thalidomide

Abbreviations used : FDA, NCS, REMS

 Funding sources: None.
 Conflicts of interest: None declared.

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