Eosinophilic fasciitis: a case series with an emphasis on therapy and induction of remission

Article Details

Authors
Rechelle Tull MD, William D Hoover III MD, Jacqueline F De Luca MD, William W Huang MD, MPH, Joseph L Jorizzo MD

Article Type
Original Research

DOI
10.7573/dic.212529

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Abstract

Eosinophilic fasciitis is an uncommon connective tissue disorder that affects patients of all ages, resulting in significant morbidity. Systemic corticosteroids can induce remission of disease. However, there is no universally accepted treatment ladder for eosinophilic fasciitis. This case series evaluates treatment efficacy in patients with eosinophilic fasciitis seen at Wake Forest University Department of Dermatology outpatient clinics. Patient charts were screened using ICD-9 diagnosis code 710.9 (unspecified diffuse connective tissue disease) to identify patients with eosinophilic fasciitis (n=10) seen at our institution. Patients were treated for an average 24 months with a combination of methotrexate and prednisone therapy, unless one or both were contraindicated, with each medication tapered conservatively to prevent disease flares. Alternate treatments included mycophenolate mofetil with prednisone, azathioprine with prednisone, prednisone monotherapy, and methotrexate monotherapy. Disease remission off therapy and on low-dose therapy was 66 and 70%, respectively. Our first-line therapy of concomitant methotrexate and prednisone is well-tolerated and effective for managing patients with eosinophilic fasciitis. Our study was limited to cases seen at a single academic institution.

Keywords: connective tissue diseases, corticosteroids, dermatology, drug therapy, eosinophilic fasciitis, immunosuppressive agents, methotrexate, prednisone.

Citation: Tull R, Hoover III WD, De Luca JF, Huang WW, Jorizzo JL. Eosinophilic fasciitis: a case series with an emphasis on therapy and induction of remission. Drugs in Context 2018; 7: 212529. DOI: 10.7573/dic.212529

Contributions: All authors had full access to all data in this study and take responsibility for the integrity of the data and accuracy of the data analysis. All authors are also responsible for study concept and design, acquisition, analysis, or interpretation of data, and initial drafting and revision of the manuscript.

Disclosure and potential conflicts of interest: Dr Jorizzo serves as a consultant for Amgen and LEO. Dr Huang serves as a consultant for AbbVie Incorporated. No other disclosures were reported. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at https://www.drugsincontext.com/wp-content/uploads/2018/08/dic.212529-COI.pdf

Acknowledgments: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2018 Tull R, Hoover III WD, De Luca JF, Huang WW, Jorizzo JL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Tull R, Hoover III WD, De Luca JF, Huang WW, Jorizzo JL. https://doi.org/10.7573/dic.212529. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/eosinophilic-fasciitis-a-case-series-with-an-emphasis-on-therapy-and-induction-of-remission

Correspondence: Joseph L Jorizzo, Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA. jjorizzo@wakehealth.edu

Provenance: invited; externally peer reviewed.

Submitted: 2 February 2018; Peer review comments to author: 13 March 2018; Revised manuscript received: 17 August 2018; Accepted: 20 August 2018; Publication date: 2 October 2018.

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