Subscribe to RSS
DOI: 10.1055/s-2005-861430
Therapie der rezidivierenden benignen Aphthosis mit Fumarsäureestern
Treatment of Recurrent Aphtous Ulcers with Fumaric AcidPublication History
Publication Date:
29 August 2005 (online)
Zusammenfassung
Die rezidivierende benigne Aphthose (RBA) wird epidemiologisch, klinisch und pathogenetisch charakterisiert und drei Subtypen werden differenziert. Die systemische Therapie von 12 RBA-Patienten über einen durchschnittlichen Zeitraum von 17 Monaten mit Fumarsäureestern wird beschrieben und der Nutzen der Behandlung für diese Patienten ausgeführt. Ein Fallbeispiel zeigt die effektive und nebenwirkungsarme Langzeit-Rezidivprophylaxe, die mit Fumarsäureestern bei einer 34-jährigen Patientin mit chronisch rezidivierender Aphthose vom Maior- (Sutton) Typ über bisher 16 Monate erzielt werden konnte. Zu den bekannten immunmodulierenden oder immunsuppressiven Therapieformen der RBA stellen Fumarsäureester in niedriger Dosierung eine viel versprechende, wirksame und gut verträgliche Ergänzung oder Alternative dar.
Abstract
Recurrent aphtous ulcers (RAU) of the oral mucosa show characteristical epidemiologic, clinic and pathogenetic features. Three subtypes can be distinguished. We describe the systemic longterm treatment of 12 RAU patients with fumaric acid and the benefit for them.
Further we present the case of a female RAU patient who, after a different initial treatment, could be protected from recurrency of aphtha by a prophylactic low dose treatment with fumaric acid over 16 months. In addition to established immunomodulating or immunosuppressive therapy of RAU fumaric acid seems to be an effective and well tolerable alternative.
Literatur
- 1 Albanidou-Farmaki E. et al . HLA-A,B,C and DR antigens in recurrent oral ulcers. Ann Dent. 1988; 47 5-8
- 2 Asadullah K. et al . Influence of monomethylfumarate on monocytic cytokine formation. ArchDermatolRes. 1997; 289 623-630
- 3 Axell T. et al . Association between recurrent aphtous ulcers and tobacco habits. Scand J Dent Res. 1985; 93 239-242
- 4 Brown R S. et al . Combination immunosuppressant and topical steroid therapy for treatment of recurrent major aphthae. Oral Surg Oral Med Oral Pathol. 1990; 69 (1) 42-44
- 5 Burton-Kee J E. et al . Different cross-reaction circulating immune complexes in Behçet's syndrome and recurrent oral ulcers. J Lab Clin Med. 1981; 97 (4) 559-567
- 6 Chellemi S J. et al . The association between smoking and aphtous ulcers. Oral Surg Oral Med Oral Pathol. 1970; 29 832-836
- 7 Cooke B ED. Recurrent oral ulcers. BrJDermatol. 1969; 81 159-161
- 8 Crivelli M R. et al . Influence of socioeconomic status on oral mucosa lesion prevalence in school children. Comm Dent Oral Epidemiol. 1988; 16 58
- 9 Dagalis P. et al . Spontaneous migration and chemotactic activity of neutrophil polymorphonuclear leucocytes in recurrent aphthous ulceration. Oral Surg Oral Med Oral Pathol. 1987; 64 298-301
- 10 Donatsky O. Comparison of cellular and humoral immunity against streptococcal and adult human oral mucosa antigens in relation to exacerbation of recurrent aphthous stomatitis. Acta Pathol Microbiol Scand. 1976; 84 (4) 270-282
- 11 Fontes V. et al . Recurrent aphthous stomatitis: treatment with colchicine. Ann Dermatol Venereol. 2002; 129 (12) 1365-1369
- 12 From the NIH . Aphtous stomatitis is linked to mechanical injuries, iron and vitamin deficiencies and certain HLA types. JAMA. 1982; 247 774-775
- 13 Gallina G. et al . HLA-A, B, C, DR, MT and MB antigen in recurrent aphtous stomatitis. Oral Surg Oral Med Oral Pathol. 1985; 59 364-370
- 14 Graykowski E A. et al . Recurrent aphtous stomatitis. JAMA. 1966; 196 129
- 15 Graykowsky E A. et al . Summary of workshop on recurrent aphtous stomatitis and Behçet syndrome. JAmDentAssoc. 1978; 97 599-602
- 16 Greenspan J S. et al . Antibody dependent cellular cytotoxicity in recurrent aphtous ulceration. ClinExpImmunol. 1981; 44 603-610
- 17 Höxtermann S. et al . Fumaric acid esters suppress peripheral CD4- and CD8-positive lymphocytes in psoriasis. Dermatology. 1998; 196 223-230
- 18 Honma T. Electron microscopic study on the pathogenesis of recurrent aphtous ulceration as compared to Behçet's syndrome. Oral Surg. 1976; 41 (3) 366-377
-
19 Hornstein O P.
Orale Schleimhautaffektionen. In: GW Korting (ed) Dermatologie in Praxis und Klinik. Vol.3. Stuttgart; 1979 - 20 Hutchinson V A. et al . Chronic recurrent aphtous stomatitis. Mol Biother. 1990; 2 160-164
- 21 de Jong R. et al . Selective stimulation of T helper 2 cytokine responses by anti-psoriasis agent monomethylfumarate. European Journal of Immunology. 1996; 26 2067-2074
- 22 Lehner T. et al . The relationship of HLA-B and DR phenotypes to Behçet's syndrome, recurrent oral ulceration and the class of immune complexes. Immunol. 1982; 47 581-587
- 23 Ockenfels H M. et al . The antipsoriatic agent dimethylfumarate immunomodulates T-cell cytokine secretion and inhibits cytokines of the psoriatic cytokine network. Br J Dermatol. 1998; 139 390-395
- 24 Pedersen A. et al . T-lymphocyte subsets in oral mucosa of patients with recurrent aphtous ulceration. J Oral Pathol Med. 1992; 21 176-180
- 25 Porter S R. et al . Aphtous stomatitis. Clin Exper Dermatol. 1991; 16 235-243
- 26 Porter S R. et al . Recurrent aphtous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies. Ann Dent. 1992; 51 14-16
- 27 Revuz J. et al . Crossover study of thalidomide vs placebo in severe recurrent aphtous stomatitis. Arch Dermatol. 1990; 126 923-926
- 28 Rodu B. et al . Oral mucosal ulcers. J Am Dent Assoc. 1992; 123 83-86
- 29 Rogers R S. et al . Lymphotoxicity in recurrent aphtous stomatitis. ArchDermatol. 1974; 109 361-363
- 30 Rogers R S. Recurrent aphtous stomatitis. Semin Cutan Med Surg. 1997; 16 278-283
- 31 Ruah C B. et al . Treatment of severe recurrent aphthous stomatitis with colchicine. Arch Otolaryngol Head Neck Surg. 1988; 114 671-675
- 32 Savage N W. et al . T-lymphocytes suset changes in recurrent aphtous stomatitis. Oral Surg Oral Med Oral Pathol. 1985; 60 175-181
- 33 Savage N W. et al . The proportion of suppressor-inducer T-lymphocytesis reduced in recurrent aphtous stomatitis. J Oral Pathol. 1988; 17 293-296
- 34 Sebök B. et al . Antiproliferative and cytotoxic profiles of antipsoriatic fumaric acid derivatives in Keratinocyte cultures. Eur J Pharmacol. 1994; 270 79-87
- 35 Shafer W G. et al .A textbook of oral pathology, ed 3. Philadelphia; WB Saunders 1974: 331-344
- 36 Shasky R G. et al . Aphtous ulcers: A difficult clinical entity. AJOT. 2000; 21 (6) 389-393
- 37 Ship J A. Inheritance of aphtous ulcers of the mouth. J Dent Res. 1965; 44 837-844
- 38 Ship J A. Recurrent aphtous stomatitis: an update. Oral Surg Oral Med Oral Pathol. 1996; 81 141-147
- 39 Sircus W. et al . Recurrent aphtous ulceration of the mouth. Q J Med. 1957; 26 235-249
- 40 Sun A. et al . Strong association of HLA-DRw9 in chinese patients with recurrent oral ulcers. JAMA. 1991; 24 195-198
- 41 Sun A. et al . Immunomodulation by levamisole in patients with recurrent aphtous ulcers or oral lichen planus. J Oral Pathol Med. 1994; 23 (4) 172-177
- 42 Sun A. et al . Serum interleukin-8 level is a more sensitive marker than serum interleukin-6 level in monitoring the disease activity of recurrent aphthous ulcerations. J Oral Pathol Med. 2004; 33 (3) 133-139
- 43 Sutton R L. Periadenitis mucosa necrotica recurrens. J Cutan Dis. 1911; 29 65-71
- 44 Taylor L J. et al . Increased production of tumor necrosis factor by peripheric blood leucocytes in patients with recurrent oral aphtous ulceration. J Oral Pathol Med. 1992; 21 21-25
- 45 Thio H B. et al . Long term systemic therapy with dimethylfumarate and monoethylfumarate in psoriasis. Journal of the EADV. 1995; 4 35-40
- 46 Vandermeeren M. et al . Dimethylfumarate is an inhibitor of cytokine-induced VCAM-1, ICAM-1 and E-Selectin expression on human endothelial cells. Biochem Biophys Res Com. 1997; 234 19-23
- 47 Weathers D R. et al . Intraoral ulcerations of recurrent herpes simplex and recurrent aphthae. JADA. 1970; 81 81-88
Prof. Dr. med. Manfred Hagedorn
Direktor der Hautklinik Klinikum Darmstadt ·
Heidelberger Landstraße 379 · 64297 Darmstadt