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LETTER TO EDITOR
Year : 1996  |  Volume : 62  |  Issue : 2  |  Page : 135-137

Pentoxiphylline in contact hypersensitivity reactions



Correspondence Address:
Kumar Sumit Bose


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Source of Support: None, Conflict of Interest: None


PMID: 20948015

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How to cite this article:
Bose KS. Pentoxiphylline in contact hypersensitivity reactions. Indian J Dermatol Venereol Leprol 1996;62:135-7

How to cite this URL:
Bose KS. Pentoxiphylline in contact hypersensitivity reactions. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2019 Nov 20];62:135-7. Available from: http://www.ijdvl.com/text.asp?1996/62/2/135/4353



  To the Editor, Top


Contact hypersensitivity reactions (CHR) are very common in day to day dermatological practice. Treatment is difficult and recurrence is common. Recently pentoxiphylline (PTX) has been tried for treating CHR. [1,2]

Twenty five cases of CHR due to air borne contact dermatitis (ABCD) [Parthenium hysterophorus], nickel allergy, microbial ides eruption, and cement allergy were selected for the PTX trial between October 1994 to October 1995. All had short courses of systemic steroids for the past 1-2 years. Six cases of ABCD (5 males and 1 female) presented with involvement of face, neck, dorsa of hand, cubital and popliteal fosae and other exposed areas depending oh the type of work. All had previous patch test with leaf extract positive. Five cases of nickel allergy (3 females and 2 males) had patch test positive and the sites of involvement were neck, wrist, dorsum of foot, suprapubic area, back and tips of fingers. Six cases of microbial ides eruption (5 males and 1 female) with lesions affecting sites of trauma, scratch or mosquito bites ie extremities, ear, scalp, leg and palms. Eight cases of cement allergy with positive patch test and all males presented either as air borne pattern, or hand and foot dermatitis affecting palm, wrist and arm, foot, dorsum of foot and lower leg. All the patients had come during the flare up of the CHR and were put on a single protocol ie, 20mg for prednisolone daily for 7 days followed by 10mg for 7 days and 10mg alternative days along with pentoxiphylline [PTX] 400mg thrice daily for 15 days. After this protocol, all patients were maintained on the same dose of PTX for six months.

In this present trial good response was observed in 4 out of 6 cases of air borne contact dermatitis (Parthenium hysterophorus), 4 in 5 of nickel allergy, 4 in 6 of microbial ides eruption, and 6 in 8 cases of cement allergy. Poor response was in 2 males (ABCD), 1 female (nickel allergy), 2 males (microbial ides eruption) and 2 males (cement allergy). Poor response was directly related to discontinuation of PTX [Table - 1]. These results indicate that PTX may be an effective alternative to steroids in controlling recurrent CHR cases.

Pentoxiphylline is a methylxanthine derivative with properties similar to theobromine, caffeine and theophylline. It has few cardiac side effects. The drug is prescribed both orally and by intravenous route. Gastrointestinal side effects can be reduced by enteric coated tablets. The drug is metabolized by red blood cells and liver with an elimination half-life of 3-4 hours.[2]

Immunological studies that indicate that PTX may be beneficial in CHR are: 1) PTX decreases neutrophil adherence and aggregation, 2) blocks IL-1 and TNFα thus reducing inflammation, 3) reduces platelet aggregation, 4) inhibits antigen and superantigen specific activation of T and B lymphocytes by inducing prostaglandin E2 synthesis.[2]

More recently [2,3] two patients with documented nickel allergy had reduced patch test reaction while on 600mg PTX four times daily throughout the patch test reading. Studies in C3H/HeN mice sensitized to dinitrofluorobenzene showed pentoxiphylline-induced suppression of the elicitation phase of dinitrofluorobenzene-induced contact hypersensitivity. Pentoxiphylline additionally exerts profound influences on granulocyte functions similar to dapsone. It inhibits free radical generation and both basal and stimulated neutrophil adhesion to bovine endothelium probably via the down regulation of neutrophil functional antigens (eg CD 11a-c, CD 18).[3]

In vitro studies also show proven effects of PTX as an anti-inflammatory agent. [2,4] All is superseded by the documentation of PTX being an immunomodulator by directly acting on cytokine production by hitherto unexplained mechainsm. It inhibits TNFα, IL-2, IFNγ, and lymphoproliferation in a dose dependent manner. Expression of both ICAM-1 and LFA-1α (leucocyte function antigen-1 alpha) is also reduced. These features were found to be augmented by the addition of dexamethasone in the culture which also selectively inhibited IL-6.[5]



 
  References Top

1.Bose SK. Pentoxifylline in the treatment of Parthenium dermatitis. JEADV 1995. In press.  Back to cited text no. 1    
2.Samlaska CP, Winfield EA. Pentoxiphylline. J Am Acad Dermatol 1994;30:603-21.  Back to cited text no. 2  [PUBMED]  
3.Nurnberg W, Grabbe J, Czarnetzki BM. Urticarial vasculitis syndrome effectively treated with dapsone and pentoxifylline. Acta Derm Venereol (Stockh) 1995;75:54-6.  Back to cited text no. 3  [PUBMED]  
4.Simic's E, Mahunka M, Horkay l,et al. Effect of pentoxifylline on sun burn cell formation in a novel supravital human skin model. Arch Dermatol Res 1995;287:384.  Back to cited text no. 4    
5.Funk JO, Ernst M, Schonharting MM, et al. Pentoxifylline and dexamethasone have partially synergistic immunomodulatory effect in vitro. Arch Dermatol Res 1995;287:400.  Back to cited text no. 5    


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