[Topical XXXX treatment for ocular cicatricial pemphigoid].

@entity1 @entity1712 @entity7674 @entity249 @entity821 @entity227 @entity267 @entity1036 @entity1066 @entity786 @entity2024 @entity1140
BACKGROUND: Ocular involvement in cicatricial pemphigoid often occurs from the onset. Certain forms are seen only in this condition. OBSERVATION: A 31-year-old @entity1 presented highly inflammatory @entity2024 for several months associated with bilateral symblepharons and superficial punctuate @entity1036 around the left eye refractory to treatment. The @entity1 had a history of mouth @entity1066 and sores on the scalp. Examination showed scalp lesions with crusts. Histological examination of these lesions revealed @entity7674 . Direct immunofluorescence showed @entity249 . Anti-basal membrane antibodies were positive. Immunotransfer confirmed the presence of circulating antibodies. This condition was controlled following administration of three courses of @entity786 as a bolus. However, the symblepharons persisted in both eyes. Improvement lasted 4 years. The @entity1 again consulted for inflammatory @entity2024 and @entity1036 resulting in invalidating loss of visual acuity, associated with @entity1712 . @entity821 eye drops alone resulted in no improvement. Treatment was initiated with topical @entity1140 (Protopic) 0.03% comprising once-daily application to the conjunctiva in the evening. This therapy was well tolerated, and 2 daily applications could be given, followed by a dosage of 0.1%. Improvement was rapid and spectacular, with @entity227 and resolution of the @entity1 's @entity1036 . Treatment was continued for 4 months and gradually reduced to the 0.03% dosage level, with increasingly wide intervals between applications. There has been no relapse within the 12 months following the end of treatment. DISCUSSION: Standard treatment of pharmacological cicatricial pemphigoid involves systemic immunosuppression since topical anti-inflammatories are ineffective. The mortality associated with this disease is due to iatrogenic complications. @entity1140 exhibits extremely good penetration of the conjunctiva. Following administration at a concentration of 0.06% 3 times daily in 15 @entity1 with inflammatory disease of the conjunctiva or the @entity267 , improvement was seen in 10 of these @entity1 at 26 weeks. @entity1140 appears to act through immunomodulatory and anti-inflammatory mechanisms. It induces local inhibition of T lymphocyte activation and reduces production of pro-inflammatory lymphokines. Oral @entity1140 cannot be used to control cicatricial pemphigoid refractory to standard immunomodulators. However, 3 three other cases involving topical treatment of cicatricial pemphigoid showed marked efficacy of treatment given for 2 to 6 months, with complete tolerability. Thus, topical @entity1140 appears to constitute an interesting alternative treatment in cicatricial pemphigoid.
