|Year : 2000 | Volume
| Issue : 2 | Page : 73-75
An open trial of pentoxifylline in schamberg's disease
Leishiowon Kumrah, Renu George, Soshamma George
Source of Support: None, Conflict of Interest: None
Fifteen patients with Schamberg's disease were enrolled in the study. Each patient was given 400mg of pentoxifylline once a day for 8 weeks. Skin biopsy was done in 6 patients to document the disease. Pretreatment and post treatment evaluation were made. There was no objective improvement in any of the patients though 4 reported subjective improvement in their pigmentation.
Keywords: Pentoxifylline, Schamberg′s disease, Purpura progressive pigmentary
|How to cite this article:|
Kumrah L, George R, George S. An open trial of pentoxifylline in schamberg's disease. Indian J Dermatol Venereol Leprol 2000;66:73-5
|How to cite this URL:|
Kumrah L, George R, George S. An open trial of pentoxifylline in schamberg's disease. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Aug 26];66:73-5. Available from: http://www.ijdvl.com/text.asp?2000/66/2/73/4873
| Introduction|| |
Schamberg's disease is a common disease and can occur at any age. The lesions can occur anywhere but are more frequent on the lower limbs. They may be a few or extensive. Clinically, the lesions present as irregualr areas of orange or brown pigmentation due to deposition of hemosiderin. It is usually asymptomatic although itching may occur sometimes. It is a chronic disease and may persist for years. The eruption may show extensions at the periphery with clearing of the old lesions. Spontaneous cure has been reported.  No therapy has been found to be consistently effective. Pentoxifylline has been tried in various inflammatory diseases such as urticarial vasculitis, leucocytoclastic vasculitis, aphthous stomatitis and contact dermatitis. It was first tried in 1994 by Wahba-Yahav et al  for a patient with Schamberg's disease associated with persistent hepatitis B antigenemia. Subsequently, Kano et al  tried pentoxifylline given at the dose of 400mg once a day for 8 weeks.
| Materials and Methods|| |
Fifteen patients with Schamberg's disease seen in the Dermatology outpatient department during November `97 - July '98, were included in the study. Skin biopsies were done to document the diagnosis whenever possible. The history and examination findings recorded in all patients included basic demographic data, duration of symptoms, presence or absence of itching and drug history. Examination findings included morphology of the lesions, extent of lesions and presence or absence of varicose veins.
Exclusion criteria included all patients with (1) severe coronary artery disease (2) acute myocaridal infarction (3) history of massive retinal haemorrhage (4) renal impairment and (5) pregnancy.
| Results|| |
Fifteen patients (12 males and 3 females) were enrolled into the study [Table - 1]. Eight (53.3%) patients, 6 males and 2 females completed the study. Of the remaining 7 patients, 6 males (40%) completed 4 weeks of treatment and 1 patient took 2 weeks of treatment. The duration of the disease ranged from 11-58 years. (Mean 31.3 years). None of the patients had varicose veins. Skin biopsy at first visit was done in 6 patients. There was no objective improvement in any of the patients. However, at the end of 8 weeks, 2 (25%) of the 8 patients reported subjective improvement in the pigmentation. One patient reported a decrease in 50% while the second patient reported 75% decrease in the pigmentation. Of the 6 patients who completed 4 weeks of pentoxifylline, 2 (33%) reported subjective improvement while the other reported 60% improvement in the skin colour. The rest of the patients reported only mild decrease in the pigmentation, except for 3, who said that there was no change in the pigmentation. None of the patients reported new lesions during the study period.
| Discussion|| |
In Schamberg's disease, Langerhans cells have been postulated to play an important role and that cellular immune reactions take place in the lesional skin.  It was recently suggested by Driesch et all that the interaction between lymphocyte function antigen (LFA) -1 on T cells and intercellular cell adhesion molecule I (ICAM-I) on endothelial cells contributes to the entry of the inflammatory cells into the skin. An active role of T cells was also indicated in these conditions by Burrows et al. 
The role of pentoxifylline in Schamberg's disease is still speculative. Pentoxifylline inhibits the production of macrophage and keratinocyte - derived cytokines such as TNF-alpha, IL -I and IL-6.  It is also known to inhibit the adhesion of leukocytes and monocytes to endothelial cells. It also
blocks the phytohaemagglutinin-induced IL-2 receptor expression by lymphocytes.  Kano et a1  tried pentoxifylline in 3 patients with Schamberg's disease. The duration of the lesions in those 3 patients ranged from 3 months to 1 year. Pentoxifylline was given at a dose of 100mg 3 times a day for 8 weeks. Clinical response was seen at 2-3 weeks and complete clearance occurred at 4 weeks. The patients were followed up for 4-7 months. One patient, whose duration of disease was 1 year and showed recurrence after 4 months, was given retreatment and the lesions resolved in 2 weeks time with no recurrence thereafter.
They postulated that the mode of action of pentoxifylline on Schamberg's disease could be by inhibiting the exocytosis of lymphocytes to the epidermis. However, in our study, pentoxifylline has no significant effect on Schamberg's disease. Although, a subjective improvement was reported by 4 (26%) of 15 patients on treatment, there was no objective improvement after treatment. None showed any change in the pigmentation. There were no new lesions in any of the patients during the study period. The apparent failure in treatment could be because hyperpigmentation takes longer to fade on pigmented skin and subtle changes in pigmentation are more difficult to detect. Further, higher doses i.e 400mg of pentoxifylline 3 times a day have been prescribed with therapeutic benefit and no untoward effects.' Larger controlled trials are required to determine the optimum dose and duration of treatment in Indian patients.
| References|| |
|1.||Champion RH. Purpura. In: Champion H, Burton JL, Ebling FJG. Text book of Dermatology. 5th Ed. Blackwell Scientific publications, 1992;1:1888-1889. |
|2.||Wahba - Yahav AV. Schamberg's purpura: association with persistent hepatitis B surface antigenemia and treatment with pentoxifylline. Cutis 1994; 54:205-1. |
|3.||Kano Y, Hirayana K, Onihara M et al. Successful treatment of Schamberg's disease with pentoxifylline. J Am Acad Dermatol (Suppl) 1997; 36: 827-830. |
|4.||Aiba S, Tagami H. Immunohistologic studies in Schamberg's disease: evidence for cellular immune reaction in lesional skin. Arch Dermatol 1988:124:1058-1062. |
|5.||Vod den Driesch P, Simon M, Jr. Cellular adhesion antigen modulation in purpura pigmentosa chronica. 3 Am Acad Dermatol 1994; 30 : 193-200. |
|6.||Burrows NP, Jones R. Cell adhesion molecule expression in capillaritis. J Am Acad Dermatol 1994; 131:826. |
|7.||Ely H. Is pentoxifylline the drug of the decade? J Am Acad Dermatol 1994; 30: 639-640. |
|8.||Rao KMK, Curie MS, McCachren SS, et al. Pentoxifylline and other methyl xanthines inhibit interleukin - 2 receptor expression in human lymphocytes. Immunology 1991; 135: 314-325. |
[Table - 1]