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Aktuelle Dermatologie 2005; 31(8/09): 383-387
DOI: 10.1055/s-2005-861430
Therapiebericht
© Georg Thieme Verlag KG Stuttgart · New York

Therapie der rezidivierenden benignen Aphthosis mit Fumarsäureestern

Treatment of Recurrent Aphtous Ulcers with Fumaric AcidM.  Hagedorn1 , T.  Glaenz1 , E.  Hasche1
  • 1 Hautklinik-Klinikum Darmstadt
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Publication History





Publication Date:
29 August 2005 (online)

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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
    PubMedGoogle Scholar
  • 2 Asadullah K. et al . Influence of monomethylfumarate on monocytic cytokine formation.  ArchDermatolRes. 1997;  289 623-630
    PubMedGoogle Scholar
  • 3 Axell T. et al . Association between recurrent aphtous ulcers and tobacco habits.  Scand J Dent Res. 1985;  93 239-242
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Chellemi S J. et al . The association between smoking and aphtous ulcers.  Oral Surg Oral Med Oral Pathol. 1970;  29 832-836
    PubMedGoogle Scholar
  • 7 Cooke B ED. Recurrent oral ulcers.  BrJDermatol. 1969;  81 159-161
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 11 Fontes V. et al . Recurrent aphthous stomatitis: treatment with colchicine.  Ann Dermatol Venereol. 2002;  129 (12) 1365-1369
    PubMedGoogle Scholar
  • 12 From the NIH . Aphtous stomatitis is linked to mechanical injuries, iron and vitamin deficiencies and certain HLA types.  JAMA. 1982;  247 774-775
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Graykowski E A. et al . Recurrent aphtous stomatitis.  JAMA. 1966;  196 129
    CrossrefPubMedGoogle Scholar
  • 15 Graykowsky E A. et al . Summary of workshop on recurrent aphtous stomatitis and Behçet syndrome.  JAmDentAssoc. 1978;  97 599-602
    PubMedGoogle Scholar
  • 16 Greenspan J S. et al . Antibody dependent cellular cytotoxicity in recurrent aphtous ulceration.  ClinExpImmunol. 1981;  44 603-610
    PubMedGoogle Scholar
  • 17 Höxtermann S. et al . Fumaric acid esters suppress peripheral CD4- and CD8-positive lymphocytes in psoriasis.  Dermatology. 1998;  196 223-230
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 19 Hornstein O P. Orale Schleimhautaffektionen. In: GW Korting (ed) Dermatologie in Praxis und Klinik. Vol.3. Stuttgart; 1979
    Google Scholar
  • 20 Hutchinson V A. et al . Chronic recurrent aphtous stomatitis.  Mol Biother. 1990;  2 160-164
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 25 Porter S R. et al . Aphtous stomatitis.  Clin Exper Dermatol. 1991;  16 235-243
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 27 Revuz J. et al . Crossover study of thalidomide vs placebo in severe recurrent aphtous stomatitis.  Arch Dermatol. 1990;  126 923-926
    CrossrefPubMedGoogle Scholar
  • 28 Rodu B. et al . Oral mucosal ulcers.  J Am Dent Assoc. 1992;  123 83-86
    PubMedGoogle Scholar
  • 29 Rogers R S. et al . Lymphotoxicity in recurrent aphtous stomatitis.  ArchDermatol. 1974;  109 361-363
    PubMedGoogle Scholar
  • 30 Rogers R S. Recurrent aphtous stomatitis.  Semin Cutan Med Surg. 1997;  16 278-283
    PubMedGoogle Scholar
  • 31 Ruah C B. et al . Treatment of severe recurrent aphthous stomatitis with colchicine.  Arch Otolaryngol Head Neck Surg. 1988;  114 671-675
    PubMedGoogle Scholar
  • 32 Savage N W. et al . T-lymphocytes suset changes in recurrent aphtous stomatitis.  Oral Surg Oral Med Oral Pathol. 1985;  60 175-181
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 34 Sebök B. et al . Antiproliferative and cytotoxic profiles of antipsoriatic fumaric acid derivatives in Keratinocyte cultures.  Eur J Pharmacol. 1994;  270 79-87
    PubMedGoogle Scholar
  • 35 Shafer W G. et al .A textbook of oral pathology, ed 3. Philadelphia; WB Saunders 1974: 331-344
    Google Scholar
  • 36 Shasky R G. et al . Aphtous ulcers: A difficult clinical entity.  AJOT. 2000;  21 (6) 389-393
    PubMedGoogle Scholar
  • 37 Ship J A. Inheritance of aphtous ulcers of the mouth.  J Dent Res. 1965;  44 837-844
    PubMedGoogle Scholar
  • 38 Ship J A. Recurrent aphtous stomatitis: an update.  Oral Surg Oral Med Oral Pathol. 1996;  81 141-147
    PubMedGoogle Scholar
  • 39 Sircus W. et al . Recurrent aphtous ulceration of the mouth.  Q J Med. 1957;  26 235-249
    PubMedGoogle Scholar
  • 40 Sun A. et al . Strong association of HLA-DRw9 in chinese patients with recurrent oral ulcers.  JAMA. 1991;  24 195-198
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 43 Sutton R L. Periadenitis mucosa necrotica recurrens.  J Cutan Dis. 1911;  29 65-71
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 45 Thio H B. et al . Long term systemic therapy with dimethylfumarate and monoethylfumarate in psoriasis.  Journal of the EADV. 1995;  4 35-40
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 47 Weathers D R. et al . Intraoral ulcerations of recurrent herpes simplex and recurrent aphthae.  JADA. 1970;  81 81-88
    PubMedGoogle Scholar

Prof. Dr. med. Manfred Hagedorn

Direktor der Hautklinik Klinikum Darmstadt ·

Heidelberger Landstraße 379 · 64297 Darmstadt

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