Recalcitrant, recurrent aphthous stomatitis successfully treated with adalimumab

Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain.
Journal of the European Academy of Dermatology and Venereology (Impact Factor: 2.83). 06/2008; 23(2):206. DOI: 10.1111/j.1468-3083.2008.02790.x
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    • "Of the drugs used, infliximab, etanercept and adalimumab appeared to improve outcomes [32]. Sanchez-Cano et al., also reported improved outcomes with adalimumab in a patients with severe aphthous ulcers [33]. The role of cytokines such as TNFα in severe aphthous stomatitis, especially in underlying disorders such as CD needs to be clarified. "
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    ABSTRACT: Adamantiades-Behçet's disease is a systemic vascular reaction/vasculitis of unknown etiology, which is characterized by periodically recurrent oral aphthous ulcers, genital ulcers, ocular inflammation that can be sight-threatening and various skin lesions, the most common of which are folliculitis and erythema nodosum. The disease can also affect a variety of other organs, including the central nervous system, the blood vessels and the gastrointestinal and respiratory tracts, leading to life-threatening complications. Early appropriate treatment is of major prognostic importance, should be based on both the type and the severity of lesions and focus on the most severe manifestation. This overview describes the present state of treatment regimens for Adamantiades-Behçet's disease. The number of randomized, controlled studies that have been conducted in this disease is limited. Topical sucralfate, rebamipide, colchicine, penicillin G benzathine plus colchicine, dapsone, thalidomide, azathioprine and interferon alfa have been found to be effective for orogenital ulcerations, whereas etanercept is used for oral ulcerations. Dapsone, thalidomide, interferon alfa and etanercept were shown to be effective against papulopustular lesions. Depot methylprednisolone, colchicine and penicillin G benzathine plus colchicine or dapsone were effective against erythema nodosum. Ciclosporin and azathioprine have shown a favorable effect on uveitis in randomized, controlled studies, while interferon alfa and tumor necrosis factor antagonists have revealed marked efficacy in retrospective studies or case series. Colchicine and azathioprine proved effective against arthritis. Finally, treatment options for vas cular, neurological and gastrointestinal disease are based on open and observational studies or case reports. Properly designed controlled studies in Adamantiades-Behçet's disease are required in order to generate optimal treatment plans for acute/chronic management and prevention of recurrence. Copyright © 2009 Prous Science, S.A.U. or its licensors. All rights reserved.
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    ABSTRACT: Recurrent Aphthous Ulceration (RAU) is a chronic oral inflammatory disease that affects approximately 25% of the general population. The etiology of the disease is unknown; however, factors that favor the onset of RAU have been correlated with a Th1 immune polarization, while factors that reduce RAU episodes have been associated with down regulation of immune reaction or stimulation of the peripheral tolerance. In this context, the integrity of the epithelial barrier is also fundamental for the prevention of the disease and conditions that augment its permeability or produce disruption are considered potential triggers. The key factor responsible for increased susceptibility is unclear, though a deficiency of Toll-like receptor (TLR) activity seems to be a good candidate. TLRs are a group of membrane proteins that recognize conserved molecules derived from bacterial, virus, fungal, or host tissues. Particularly, the TLR2 is involved in both immune regulation and control of epithelial barrier integrity. Thus, based on literature review, we showed evidences that correlate the TLR2 dysfunction and the diverse predisposing factors with the elements considered critical for disease pathogenesis: the Th1 immune reaction and the increased epithelial permeability.
    01/2010; 2010(2090-1526). DOI:10.1155/2010/163804
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