Tuesday, May 24, 2011

Eosinophilic fasciitis - Treatment

Before the treatment for eosinophilic fasciitis, especially second-line agents, should know that one third of cases heal spontaneously.
Initial therapy:There is a consensus on the use of systemic corticosteroids as initial therapeutic agents of choice. Prednisone and prednisolone are used. The answer is considered satisfactory when swelling occurs, a contracture, carpal tunnel syndrome and skin thickening.Eosinophilia and inflammatory markers often resolve after initiation of therapy with prednisone.
Second-line therapy:Have been used multiple additional therapeutic agents for steroid-resistant disease. There is no general consensus on the best agent in this group. They include antihistamines, hidroxicloroquina, azathioprine, cyclosporine, dapsone, infliximab, tacrolimus, methotrexate, D-penicillamine, griseofulvin, ketotifen, alpha-interferon. Some data suggest that agents anti-tumor necrosis factor may also be beneficial. Should start physical therapy to improve mobility and decrease joint contractures. Issue surgery was useful in some cases of severe joint contractures.
Prognosis:A recent retrospective study found that clinical factors associated with persistent fibrosis morfealike include skin lesions, young age at onset, affecting the trunk and this fibrosclerozei dermal histopathology.Decrease edema is usually the first clinical sign of improvement and can occur at 4 weeks after treatment. The skin becomes softer, but the disease can relapse 3-6 months before the maximum reduction of induration and contraction. Safety precautions during the total resolution of clinical signs can occur, some degree of mercy remain even after months of corticosteroid therapy.A direct correlation between clinical disease and laboratory tests did not always exist. Eosinophilia and ESR return to normal in 6-8 weeks, although ESR and hypergammaglobulinemia may remain abnormal for 12 weeks. development of aplastic anemia is a rare but serious complication.Numerous cases of necrotizing eoziofilica respond to corticosteroid therapy, a quarter of which get complete healing, although spontaneous resolution is possible. Full recovery may take 1-3 years. There is no consensus on treatment, but studies indicate that is the best treatment with moderate doses of corticosteroids, especially if started early in the disease.

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