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Medication

Medication Summary

In described cases of Cronkhite-Canada syndrome (CCS), drugs used include corticosteroids, mesalamine (also known as mesalazine or 5-aminosalicylic acid),^[71]tumor necrosis factor (TNF) inhibitors (infliximab), and antibiotics (ie, tetracycline, metronidazole). Immunosuppressive treatment with azathioprine, sirolimus, and calcineurin inhibitors, such as cyclosporine, should be considered for patients with steroid-resistant Cronkhite-Canada syndrome.^{[20, 66]}

H1- and H2-receptor blockers have been used. Therapy with antiplasmin agents has also been reported. These agents interfere with fibrinolysis in the gastrointestinal tract, thereby reducing the loss of proteins.

Class Summary

Corticosteroids inhibit inflammation within gastrointestinal mucosa.

Prednisone (Deltasone)

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Prednisone is used as an immunosuppressant to treat immune disorders. It decreases inflammatory reactions by reversing increased capillary permeability and inhibits antigen-antibody binding.

Class Summary

Antibiotics are used for the concomitant bacterial overgrowth syndrome within gastrointestinal mucosa.

Tetracycline (Sumycin)

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Tetracycline treats gram-positive and gram-negative organisms and mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunit(s).

Metronidazole (Flagyl)

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Metronidazole is used to inhibit the concomitant bacterial overgrowth syndrome within gastrointestinal mucosa. It is an imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Metronidazole is used in combination with other antimicrobial agents (except for C difficile enterocolitis).

Class Summary

The use of biologic response modifiers that target TNF and other cytokines represents an advance in the treatment of several diseases involving autoimmune mechanisms. TNF inhibitors help stop inflammation.

Infliximab (Inflectra, Infliximab-abda, Infliximab-dyyb)

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This is off-label use. Infliximab is a recombinant humanized monoclonal anti-TNF-alfa antibody; it prevents synovial and intestinal inflammation.

Class Summary

Anti-inflammatories inhibit inflammatory lesions within gastrointestinal mucosa.

Mesalamine (Rowasa, Asacol, Pentasa)

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Mesalamine reduces the production of nitric oxide and superoxides, and the regulatory effect on leukotriene B4 results in inhibition of inflammation in the gastrointestinal tract. Mesalamine treats mildly to moderately active ulcerative colitis. The usual course of therapy in adults is 3-6 weeks. Some patients may need concurrent rectal and oral therapy.

Class Summary

Proton pump inhibitors inhibit gastric acid secretion by inhibition of the H⁺/K⁺/ATP-ase enzyme system in the gastric parietal cells.

Omeprazole (Prilosec)

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Omeprazole decreases gastric acid secretion by inhibiting the parietal cell H⁺/K⁺ -ATPase pump. It is indicated for gastric ulcers, duodenal ulcers, GERD, erosive esophagitis, and eradication of H pylori when combined with other medications.

Class Summary

An increased gastric acid secretion is found in some patients with Cronkhite-Canada syndrome.

Ranitidine (Zantac)

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Ranitidine inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and hydrogen concentrations.

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Author

Melba Estrella, MD Research Fellow, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Additional Contributors

Franklin Flowers, MD Professor Emeritus, Department of Dermatology, Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

Agnieszka B Serwin, MD, PhD Consulting Staff, Department of Dermatology and Venereology, Medical Academy of Bialystok, Poland

Disclosure: Nothing to disclose.

Kruti Parikh Rutgers Robert Wood Johnson Medical School

Disclosure: Nothing to disclose.

Acknowledgements

Hanna Mysliwiec, MD Staff Physician, Department of Dermatology and Venereology, Medical Academy of Bialystok, Poland

Disclosure: Nothing to disclose.

Cronkhite-Canada Syndrome Medication

Medication Summary

Corticosteroids

Class Summary

Prednisone (Deltasone)

Prednisone (Deltasone)

Antibiotics

Class Summary

Tetracycline (Sumycin)

Tetracycline (Sumycin)

Metronidazole (Flagyl)

Metronidazole (Flagyl)

DMARDs, TNF Inhibitors

Class Summary

Infliximab (Inflectra, Infliximab-abda, Infliximab-dyyb)

Infliximab (Inflectra, Infliximab-abda, Infliximab-dyyb)

Anti-inflammatories

Class Summary

Mesalamine (Rowasa, Asacol, Pentasa)

Mesalamine (Rowasa, Asacol, Pentasa)

Proton pump inhibitors

Class Summary

Omeprazole (Prilosec)

Omeprazole (Prilosec)

Histamine H2 blockers

Class Summary

Ranitidine (Zantac)

Ranitidine (Zantac)

Cronkhite-Canada Syndrome Medication

Medication Summary

Corticosteroids

Class Summary

Prednisone (Deltasone)

Prednisone (Deltasone)

Antibiotics

Class Summary

Tetracycline (Sumycin)

Tetracycline (Sumycin)

Metronidazole (Flagyl)

Metronidazole (Flagyl)

DMARDs, TNF Inhibitors

Class Summary

Infliximab (Inflectra, Infliximab-abda, Infliximab-dyyb)

Infliximab (Inflectra, Infliximab-abda, Infliximab-dyyb)

Anti-inflammatories

Class Summary

Mesalamine (Rowasa, Asacol, Pentasa)

Mesalamine (Rowasa, Asacol, Pentasa)

Proton pump inhibitors

Class Summary

Omeprazole (Prilosec)

Omeprazole (Prilosec)

Histamine H2 blockers

Class Summary

Ranitidine (Zantac)

Ranitidine (Zantac)

References

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