Thalidomide in Refractory Vulvar Ulcerations Associated with Crohn’s Disease

Abstract

We report a case of recurrent vulvar ulcerations developed on vegetations associated with Crohn’s disease. Lesions responded to low-dose thalidomide treatment. A biopsy revealed a neutrophilic infiltrate with rare giant cells. Vulvar manifestations were consistent with metastatic Crohn’s disease or with a reactive neutrophilic dermatitis. Thalidomide reduces the activity of tumor necrosis factor (TNF) α by accelerating the degradation of its mRNA. Nowadays, it has become a promising drug in a broad variety of disorders in which TNF-α seems to play a pivotal role, including inflammatory bowel diseases. This is the first case report presenting the efficacy of thalidomide in the treatment of vulvar involvement in Crohn’s disease.

Maladie de Crohn à expression vulvopérinéale exclusive

“…Ses risques d'utilisation et son coût le réservent aux formes vulvaires sévères. Le thalidomide, autre médicament à action anti-TNFα, a été utilisé avec succès à faible dose chez une patiente atteinte de Crohn vulvaire [10]. …”

Scleromyxedema, a Positive Effect with Thalidomide

“…Originally, thalidomide was recognized for its role in the treatment of erythema nodosum leprosum; however, thalidomide’s effectiveness is now well documented in a variety of diseases including aphthous stomatitis, discoid lupus erythematosus, actinic prurigo, Behçet’s disease, prurigo nodularis, cutaneous Langerhans cell histiocytosis, vulvar ulcerations associated with Crohn’s disease and HIV-associated dermatological conditions[ 30, 34, 35]. …”

Aseptic Neutrophilic Abscess of the Vulva

“…The lack of clinical or biological signs suggesting either a joint or bowel infl ammatory disease [5] , Behçet disease or a malignant haemopathy together with the patient's complete recovery after her child's birth are in favour of a gravidic neutrophilic dermatosis.…”