Dermatologic Manifestations of Hypereosinophilic Syndrome Medication

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 2, 2011
 

Medication Summary

Therapy is geared toward reducing organ damage. Corticosteroids are the initial drugs of choice, and prednisone produces a response in approximately 66% of patients. A response to prednisone manifests as a reduction in the eosinophil count within 48 hours. Usually, the response is more rapid.

Imatinib, which blocks the effects of platelet-derived growth factor, has transformed the care of a large subset of patients with hypereosinophilic syndrome and can be helpful. It can lead to a sustained drop in the eosinophil count. However, because the causes of hypereosinophilic syndrome are variable, predicting the responsiveness of a patient to imatinib mesylate therapy remains difficult.

For conditions unresponsive to prednisone, chemotherapeutic and biologic agents can be used. The toxicity of these agents should always be considered, and the risk-benefit ratio of these treatments must be assessed.

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Corticosteroids

Class Summary

These agents rapidly suppress peripheral eosinophil counts. They have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

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Prednisone (Deltasone, Meticorten, Orasone, Sterapred)

 

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocyte and antibody production.

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Antineoplastics

Class Summary

These agents interfere with cell division, thus reducing eosinophil production. They are particularly toxic to rapidly dividing cells.

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Hydroxyurea (Hydrea)

 

Interferes with DNA synthesis. Used to reduce total leukocyte count to < 10,000/μ L. Requires 7-14 d for effectiveness.

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Vincristine (Oncovin, Vincasar)

 

Inhibits cellular mitosis by inhibition of intracellular tubulin function, binding to microtubule and spindle proteins in the S phase. Used to reduce total leukocyte count to < 10,000/μ L. Effective in 1-3 d and spares bone marrow toxicity but may cause paresthesias.

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Chlorambucil (Leukeran)

 

Alkylates and cross-links strands of DNA, inhibiting DNA replication and RNA transcription. Used to reduce total leukocyte count to < 10,000/μ L.

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Immunomodulators

Class Summary

Empirically applied to many diseases as immunomodulator.

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Interferon alfa 2a and 2b (Intron A, Roferon)

 

Reported to reduce eosinophil counts in some patients.

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Immunosuppressants

Class Summary

These agents inhibit key factors in the immune system that are responsible for immune reactions.

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Cyclosporine (Neoral, Sandimmune)

 

Cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions. Not approved for this use. May be combined with prednisone.

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Imatinib mesylate (Gleevec)

 

Specifically designed to inhibit tyrosine kinase activity of the bcr-abl kinase in Ph+ leukemic CML cell lines. Used to treat CML in blast crisis, accelerated phase, or in chronic phase after failure to interferon alfa therapy. Well absorbed after oral administration, with maximum concentrations achieved within 2-4 h. Elimination is primarily in feces in form of metabolites.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Felix Urman, MD  Staff Physician, Department of Dermatology, St Luke's Roosevelt Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Takeji Nishikawa, MD  Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Petechiae on an erythematous base.
 
 
 
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