Effective treatment of scabetic nodules with thalidomide: a 5-year retrospective case series

BACKGROUND: Scabetic nodules are a cutaneous hypersensitivity reaction to scabies mites and their byproducts, often accompanied by persistent pruritus. These nodules remain a therapeutic challenge due to the lack of effective treatments. OBJECTIVE: We sought to assess the effectiveness and tolerance of thalidomide for genital scabetic nodules. METHODS: We performed a retrospective evaluation of thalidomide treatment (50-200 mg/day for 2-3 consecutive weeks) in 38 male patients with genital nodular scabies who had previously been infested with scabies mites and were left with persistent pruritic nodules on the genitals. RESULTS: A total of 38 male patients (age range: 18-40 years; mean age: 28.2 ± 5.79 years) with post scabetic nodules were included. Some of them had been refractory to other forms of therapy. Of the 38 patients, 28 patients (73.7%) showed nodule resolution after 2 weeks of treatment. A significant reduction in the number of nodules was observed at the end of the three-week treatment period (P < 0.05), and there was no sign of relapsing. Meanwhile, after two weeks of thalidomide treatment, the patient's pruritus symptoms significantly improved, manifested as a significant decrease in VAS (P < 0.05), and after three weeks of treatment, VAS further significantly decreased (P < 0.05). Infrequent adverse events, including rash, mild dizziness, and/or drowsiness, occurred in nine patients and resolved after drug withdrawal. CONCLUSION: Thalidomide may be a promising option for treating refractory scabies nodules. CLINICAL TRIAL: Not applicable.