Thalidomide for recurrent erythema multiforme

A diagnosis of localized bullous pemphigoid was made and the patient was treated with prednisolone in a dosage of 1 5 mg daily and showed complete resolution of the lesions within a week. The dose of prednisolone was gradually reduced over the next 2 months and then stopped. Over the next 9 months she had several recurrences with vesicular lesions at the same site on the nose that were controlled using topical corticosteroids. Irradiation with ultraviolet light is known to induce the local production and release of inflammatory mediators such as epidermal cytokines that include interleukin 1. interleukin 6, tumour necrosis factor a. granulocyte-macrophage colony stimulating factors and some suppressor factors.' ^ These cytokines can attract and activate a variety of circulating and resident cells, producing localized inflammation and tissue damage.-' This may result in the exposure of the buflous pemphigoid antigens."' The overproduction of cytokines or dysregulation of the cytokine cascade can also amplify the interaction hetween lymphocytes and specific antigens to generate immunological reactivities.'' ' These events may trigger the induction of localized pemphigoid in an immunologically susceptible individual at the site of injury.''' Our patient developed blistering lesions on the nose following sun exposure even though the expression of the pemphigoid antigen has been found to be low in facial skin.**