02548nas a2200541   4500000000100000008004100001260001600042653001500058653001000073653003100083653003100114653001400145653002100159653001900180653002000199653001100219653002400230653002100254653002300275653002500298653000900323653001600332653002400348653005200372653001900424653000900443653001600452100001400468700001200482700001400494700001600508700001500524700001600539700001500555700001800570700001100588700001600599700001300615700001300628700001300641245010900654856006000763300001200823490000800835050001700843520113200860022001401992       2005                            d  c2005 Dec 1510aAdolescent10aAdult10aCD4-Positive T-Lymphocytes10aCD8-Positive T-Lymphocytes10aCytokines10aErythema Nodosum10aFlow Cytometry10aGene Expression10aHumans10aImmunologic Factors10aInterferon-gamma10aLeprostatic Agents10aLeprosy, lepromatous10aMale10aMiddle Aged10aProspective Studies10aReverse Transcriptase Polymerase Chain Reaction10aRNA, Messenger10aSkin10aThalidomide1 aHaslett P1 aRoche P1 aButlin CR1 aMacdonald M1 aShrestha N1 aManandhar R1 aLemaster J1 aHawksworth RA1 aShah M1 aLubinsky SA1 aAlbert M1 aWorley J1 aKaplan G00aEffective treatment of erythema nodosum leprosum with thalidomide is associated with immune stimulation.  uhttps://academic.oup.com/jid/article/192/12/2045/839139  a2045-530 v192  aHASLETT 20053 a<p>The immunomodulatory drug thalidomide is the treatment of choice for erythema nodosum leprosum (ENL), an inflammatory cutaneous and systemic complication of multibacillary leprosy. To elucidate the mechanism of action of thalidomide in this syndrome, we prospectively investigated 20 patients with ENL who were treated with thalidomide for 21 days. All patients responded to treatment, with the majority of them having complete resolution of cutaneous lesions within 7 days. This response was associated with a marked but transient increase in ex vivo mitogen-induced expression of interleukin (IL)-2 and interferon- gamma by CD4(+) and CD8(+) T cells that was observed on treatment day 7, but these returned to pretreatment levels by day 21. Plasma tumor necrosis factor- alpha levels were not high at baseline, and they increased modestly during treatment. Plasma levels of IL-12 increased steadily during thalidomide treatment. Hence, the therapeutic effect of thalidomide in ENL appears to be associated with transient immune stimulation, which suggests that the drug may promote an active immunoregulatory response.</p>  a0022-1899