Kimura Disease Treatment & Management

  • Author: Karolyn A Wanat, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 11, 2010
 

Medical Care

  • Observation is acceptable if the Kimura disease lesions are neither symptomatic nor disfiguring.
  • Intralesional or oral steroids can shrink the nodules but seldom result in cure. A medium-potency steroid (eg, triamcinolone acetonide), used in solution form for intralesional injection, is usually well tolerated.
  • Radiotherapy has occasionally been used to treat recurrent or persistent Kimura disease lesions. A report by Hareyama et al[14] reported on the use of radiotherapy at dosages of 26-30 Gy; local control was achieved in 74% of lesions. Another study demonstrated that radiotherapy (20-45 Gy) was more effective than local excision and steroid treatment, with local response rates of 64.3% vs 22.2%, respectively. No adverse effects were observed during a mean follow-up period of 65 months.[15] However, considering the benign nature of Kimura disease, further investigation may be required, and caution using radiation outside of recurrent, disfiguring lesions is required.
  • Cyclosporine has been reported to induce remission in patients with Kimura disease. A dose of 5 mg/kg/d was effective, but, in most cases, the lesions recurred upon cessation of therapy.[16]
  • Oral pentoxifylline has been reported to be effective in one patient with Kimura disease; however, the lesions relapsed after discontinuation of therapy.[17]
  • All trans -retinoic acid in combination of prednisone has resulted in remission of Kimura disease in one patient, and he remained disease free 12 months after discontinuation of all therapy.[18]
  • Imatinib may be an effective treatment for Kimura disease, based on advances in research for therapy in hypereosinophilic syndrome, but further investigation is necessary.[7]
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Surgical Care

  • Conservative surgical excision is considered the treatment of choice for Kimura disease; however, lesions often recur after excision.
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Consultations

  • Consultation with an otolaryngologist or ophthalmologist should be considered for further evaluation depending on the extent and location of the disease.
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Contributor Information and Disclosures
Author

Karolyn A Wanat, MD  Resident Physician, Department of Dermatology, University of Pennsylvania School of Medicine

Karolyn A Wanat, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and American Medical Women's Association

Disclosure: Nothing to disclose.

Coauthor(s)

Alaina J James, MD, PhD  Assistant Professor, Department of Dermatology, The Hospital of the University of Pennsylvania

Alaina J James, MD, PhD is a member of the following medical societies: American Academy of Dermatology, National Medical Association, and Women's Dermatologic Society

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.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Daniel S Loo, MD  Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center

Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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

Disclosure: Nothing to disclose.

References

  1. Kimm HT, Szeto C. Eosinophilic hyperplastic lymphogranuloma, comparison with Mikulicz's disease. Proc Chin Med Soc. 1937;329.

  2. Kimura T, Yoshimura S, Ishikawa E. On the unusual granulation combined with hyperplastic changes of lymphatic tissues. Trans Soc Pathol Jpn. 1948;37:179-80.

  3. Thomas J, Jayachandran NV, Chandrasekhara PK, Rajasekhar L, Narsimulu G. Kimura's disease--an unusual cause of lymphadenopathy in children. Clin Rheumatol. May 2008;27(5):675-7. [Medline].

  4. Mrówka-Kata K, Kata D, Kyrcz-Krzemien S, Helbig G. Kikuchi-Fujimoto and Kimura diseases: the selected, rare causes of neck lymphadenopathy. Eur Arch Otorhinolaryngol. Oct 16 2009;[Medline].

  5. Rajpoot DK, Pahl M, Clark J. Nephrotic syndrome associated with Kimura disease. Pediatr Nephrol. Jun 2000;14(6):486-8. [Medline].

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  8. Kung IT, Gibson JB, Bannatyne PM. Kimura's disease: a clinico-pathological study of 21 cases and its distinction from angiolymphoid hyperplasia with eosinophilia. Pathology. Jan 1984;16(1):39-44. [Medline].

  9. Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: a clinicopathologic study of 21 cases. Am J Surg Pathol. Apr 2004;28(4):505-13. [Medline].

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  11. Ohta N, Okazaki S, Fukase S, Akatsuka N, Aoyagi M, Yamakawa M. Serum concentrations of eosinophil cationic protein and eosinophils of patients with Kimura's disease. Allergol Int. Mar 2007;56(1):45-9. [Medline].

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  13. Birol A, Bozdogan O, Keles H, et al. Kimura's disease in a Caucasian male treated with cyclosporine. Int J Dermatol. Dec 2005;44(12):1059-60. [Medline].

  14. Hareyama M, Oouchi A, Nagakura H, et al. Radiotherapy for Kimura's disease: the optimum dosage. Int J Radiat Oncol Biol Phys. Feb 1 1998;40(3):647-51. [Medline].

  15. Chang AR, Kim K, Kim HJ, Kim IH, Park CI, Jun YK. Outcomes of Kimura's disease after radiotherapy or nonradiotherapeutic treatment modalities. Int J Radiat Oncol Biol Phys. Jul 15 2006;65(4):1233-9. [Medline].

  16. Kaneko K, Aoki M, Hattori S, Sato M, Kawana S. Successful treatment of Kimura's disease with cyclosporine. J Am Acad Dermatol. Nov 1999;41(5 Pt 2):893-4. [Medline].

  17. Hongcharu W, Baldassano M, Taylor CR. Kimura's disease with oral ulcers: response to pentoxifylline. J Am Acad Dermatol. Nov 2000;43(5 Pt 2):905-7. [Medline].

  18. Boulanger E, Gachot B, Verkarre V, Valensi F, Brousse N, Hermine O. all-trans-Retinoic acid in the treatment of Kimura's disease. Am J Hematol. Sep 2002;71(1):66. [Medline].

  19. Armstrong WB, Allison G, Pena F, Kim JK. Kimura's disease: two case reports and a literature review. Ann Otol Rhinol Laryngol. Dec 1998;107(12):1066-71. [Medline].

  20. Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: a clinicopathologic study of 21 cases. Am J Surg Pathol. Apr 2004;28(4):505-13. [Medline].

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  22. Googe PB, Harris NL, Mihm MC Jr. Kimura's disease and angiolymphoid hyperplasia with eosinophilia: two distinct histopathological entities. J Cutan Pathol. Oct 1987;14(5):263-71. [Medline].

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  25. Katagiri K, Itami S, Hatano Y, Yamaguchi T, Takayasu S. In vivo expression of IL-4, IL-5, IL-13 and IFN-gamma mRNAs in peripheral blood mononuclear cells and effect of cyclosporin A in a patient with Kimura's disease. Br J Dermatol. Dec 1997;137(6):972-7. [Medline].

  26. Kuo TT, Shih LY, Chan HL. Kimura's disease. Involvement of regional lymph nodes and distinction from angiolymphoid hyperplasia with eosinophilia. Am J Surg Pathol. Nov 1988;12(11):843-54. [Medline].

  27. Matsuda O, Makiguchi K, Ishibashi K, et al. Long-term effects of steroid treatment on nephrotic syndrome associated with Kimura's disease and a review of the literature. Clin Nephrol. Mar 1992;37(3):119-23. [Medline].

  28. Senel MF, Van Buren CT, Etheridge WB, Barcenas C, Jammal C, Kahan BD. Effects of cyclosporine, azathioprine and prednisone on Kimura's disease and focal segmental glomerulosclerosis in renal transplant patients. Clin Nephrol. Jan 1996;45(1):18-21. [Medline].

  29. Som PM, Biller HF. Kimura disease involving parotid gland and cervical nodes: CT and MR findings. J Comput Assist Tomogr. Mar-Apr 1992;16(2):320-2. [Medline].

  30. Wang YS, Tay YK, Tan E, Poh WT. Treatment of Kimura's disease with cyclosporine. J Dermatolog Treat. 2005;16(4):242-4. [Medline].

  31. Yoganathan P, Meyer DR, Farber MG. Bilateral lacrimal gland involvement with Kimura disease in an African American male. Arch Ophthalmol. Jun 2004;122(6):917-9. [Medline].

  32. Yuen HW, Goh YH, Low WK, Lim-Tan SK. Kimura's disease: a diagnostic and therapeutic challenge. Singapore Med J. Apr 2005;46(4):179-83. [Medline].

 
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