Dermatologic Manifestations of Mixed Connective Tissue Disease Medication
- Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD more...
Mixed connective-tissue disease (MCTD) is a chronic and usually mild disease, which can be treated symptomatically or with corticosteroids or immunosuppressives if the severity of disease justifies it. Combined treatment allows dose reduction of systemic steroids (corticosteroid-sparing effect). Treatment depends on internal organ involvement. Midrange doses of systemic corticosteroids have been used in conjunction with immunosuppressive agents. Anti-inflammatory agents are helpful for arthralgia, myalgia, and swelling of the hands. Skin lesions can be treated with topical corticosteroids. In all cases, photoprotection is recommended.
These agents decrease autoimmune reactions, possibly by suppressing key components of the immune system. They are often used to treat collagen vascular diseases.
Prednisolone is a synthetic adrenocortical steroid with predominantly glucocorticoid properties. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reducing capillary permeability.
These agents inhibit key factors that mediate immune reactions, which in turn decrease inflammatory responses.
Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions (eg, delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft-vs-host disease) in a variety of organs. For children and adults, base dosing on ideal body weight. Onset of action is 1-2 months; stabilization of disease may take 3-4 months. Bioavailability is not necessarily equal in different formulations; use caution. In severe disease, higher doses (transplant dosing) increases risk of adverse events and may be beyond the scope of practice for a general dermatologist.
Nonsteroidal anti-inflammatory drugs
NSAIDs provide symptomatic relief for arthralgia, myalgia, edema, and tenderness.
Naproxen is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase, which decreases prostaglandin synthesis.
Topical corticosteroids are moderate or potent agents with anti-inflammatory and immunosuppressive properties. They can decrease epidermal proliferation.
Fluticasone has extremely potent vasoconstrictive and anti-inflammatory activities. It has a weak inhibitory affect on the hypothalamic-pituitary-adrenocortical axis when applied topically. Other more potent topical corticosteroids may be useful for unresponsive inflammatory skin lesions. Less potent nonfluorinated topical corticosteroids may be useful in patients with less aggressive skin disease. Fluticasone is of medium potency.
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