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NR 10-12/2005
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Diagnostyka i
leczenie zachowawcze ocznego pemfigoidu bliznowaciejącego
Diagnostics and
farmacological treatment of ocular cicatrical pemphigoid
Joanna Brydak-Godowska1,
Joanna Moneta-Wielgoś1, Magdalena Pauk-Domańska1,
Ewa Dróbecka-Brydak1, Agnieszka Samsel1,
Mariusz Kęcik1, Cezary Kowalewski2,
Wojciech Mackiewicz2, Dariusz Kęcik1
1Z Katedry i Kliniki Chorób Oczu Akademii Medycznej w
Warszawie
Kierownik: dr hab. n. med. Dariusz Kęcik
2Z Katedry i Kliniki Dermatologii Akademii Medycznej
w Warszawie
Kierownik: prof. dr hab. n. med. Maria Błaszczyk-Kostanecka |
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| Summary: |
Ocular cicatricial
pemphigoid (OCP) is an autoimmune disease characterize
by mucous membrane fibrosis and skin changes resulting
with scarring. The pathogenic mechanisms of ocular
cicatricial pemphigoid are incompletely understood.
Antibasement membrane antibodies which lead to
subepithelial blistering, granulation tissue and
inflammatory infiltrate formation in the substantia
propria are thought to be the main pathophysiological
mechanisms in cicatricial pemphigoid. It has been found
eosinophils and increased collagen type I and III. Human
leukocyte antigen HLA-DR2, HLA-DR4 and DQw7 genotypes
have been identified as conferring increased
susceptibility to the development of this disease.
Ocular cicatrical pemphigoid (OCP) is one of the forms
of bullous pemphigoid. Initial symptoms of ocular
pemfigoid are not characteristic. Conjunctival fibrosis
may cause severe entropion, trichiasis, symblepharon,
dry eye syndrome, corneal epithelial erosions or
ulceration. Secondary glaucoma is one of the most
frequent complications. Ocular cicatricial pemphigoid
may be chronic, acute, or subacute disease with periodic
exacerbation of conjunctival inflammation. The treatment
in this disease are topical drops or ointment (lubricants,
corticosteroids, antibiotics, antiglaucomatous). Oral
dapsone and corticosteroids may control the activity of
the disease. In other progressive cases
immunosuppressive drugs must be used (azathioprine,
cyclophosphamide, methotrexate, mycophenolan mofetil,
daclizumab, intravenous immunoglobulin therapy). To make
an early diagnosis of ocular cicatricial pemphigoid,
biopsy and immunohistochemical analysis of conjunctiva
should be performed in every case of persistent
conjunctival inflammation. |
| Słowa kluczowe: |
pemfigoid oczny,
przewlekłe zapalenie spojówek, bliznowacenie, biopsja
spojówki, immunosupresja. |
| Key words: |
ocular pemphigoid, chronic
conjunctivitis, scarring, conjunctival biopsy,
immunosuppression. |
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