No systematic reviews or RCTs of the role of thalidomide in the treatment of cutaneous sarcoidosis were found. One retrospective study was identified by Estines et al51 on data collected on 10 patients with severe disfiguring lesions treated with thalidomide, 1-84mg/kg, who were resistant to conventional therapy. Outcomes measured were: complete regression (total disappearance); incomplete regression (remaining signs) and treatment failure (no change, or worsening). Three of the study participants had complete regression, four had incomplete regression, and treatment failed in three. The thalidomide dose was gradually reduced for five of the seven patients for whom thalidomide was effective; three of the five patients relapsed, but the drug was efficacious at re-introduction at the same dose.

Three case reports of patients successfully treated with thalidomide for lesions resistant to other forms of therapy were found.49,50,52 Carlisimo et al.49 report on a 56-year-old woman with cutaneous sarcoid unresponsive to steroids who had clinical improvement after taking thalidomide, 200 mg/day for 2 weeks followed by 100 mg/day for 11 weeks. Rousseau et al50 report on a 30-year-old woman resistant to intralesional steroids, hydroxychloroquine, isotretinoin and isoniazid; she improved with thalidomide, 100 mg/day for 2 months, gradually tapered to a maintenance dose of 50 mg/day. Lee et al.52 report on a 59-year-old patient who had clinical improvement of all lesions after taking thalidomide 200mg/day for 2 months and 300 mg/day for 4 months.

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