Dermatologic Manifestations of Hypereosinophilic Syndrome Medication

Updated: Aug 21, 2019
  • Author: Felix Urman, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

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. Rarely, treatment is not needed; a case of hypereosinophilic syndrome with skin findings in a 4-month-old with spontaneous resolution without treatment has been reported. [62]

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.

Prednisone (Deltasone, Meticorten, Orasone, Sterapred)

Prednisone is an immunosuppressant for treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone 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.

Hydroxyurea (Hydrea)

Hydroxyurea interferes with DNA synthesis. It is used to reduce the total leukocyte count to less than 10,000/μ L. Hydroxyurea requires 7-14 days for effectiveness.

Vincristine (Oncovin, Vincasar)

Vincristine inhibits cellular mitosis by the inhibition of intracellular tubulin function, binding to microtubule and spindle proteins in the S phase. It is used to reduce the total leukocyte count to less than 10,000/μ L. Vincristine is effective in 1-3 days and spares bone marrow toxicity but may cause paresthesias.

Chlorambucil (Leukeran)

Chlorambucil alkylates and cross-links strands of DNA, inhibiting DNA replication and RNA transcription. It is used to reduce the total leukocyte count to less than 10,000/μ L.

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Immunomodulators

Class Summary

These agents are empirically applied to many diseases as immunomodulators.

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

Interferon alfa 2a and 2b are 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.

Cyclosporine (Neoral, Sandimmune)

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions. Cyclosporine is not approved for this use; it may be combined with prednisone.

Imatinib mesylate (Gleevec)

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

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