L-tryptophan ingestion associated with eosinophilic fasciitis but not progressive systemic sclerosis

Article Abstract:

Eosinophilic fasciitis is characterized by inflammation of the fascia, the membrane surrounding the muscles; sclerosis, causing hardening of the skin; and eosinophilia, an increase in granular white blood cells. Because the Centers for Disease Control reported a link between ingestion of the amino acid L-tryptophan and a syndrome of eosinophilia and myalgia (muscle pain), the use of L-tryptophan was assessed among eight patients with eosinophilic fasciitis. All patients had taken L-tryptophan before developing the disease and had myalgia and eosinophilia. L-tryptophan was taken for less than eight months by six patients, and for nine years by one patient. Hypothyroidism (decreased thyroid gland activity) was newly diagnosed in two cases, nerve disease was found in two other cases, and severe muscle contractures were identified in another two cases. Antinuclear antibodies, abnormal immune proteins that bind to the DNA in cells, were detected in five patients with eosinophilic fasciitis. This may indicate an autoimmune process, in which immune cells and proteins attack body tissues and natural factors. Although corticosteroid drugs were only partially effective in most patients, isotretinoin slowed the disease progression in one case. Among 40 patients with scleroderma, a disorder characterized by thickening of the skin and other tissues, only one patient had used L-tryptophan before disease onset. The results show that L-tryptophan use may lead to eosinophilic fasciitis but not scleroderma, and disease remission may not occur with drug withdrawal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Causes of, Tryptophan, Fasciae (Anatomy), Eosinophil disorders, Fasciitis

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Extracorporeal photochemotherapy for drug-resistant pemphigus vulgaris

Article Abstract:

Four case studies are presented in which patients with pemphigus vulgaris were treated with photochemotherapy. In this procedure, the white blood cells of the patient are extracorporeally exposed, meaning exposed outside the body, to the compound 8-methoxypsoralen (8-MOP) and ultraviolet radiation. Pemphigus vulgaris is an autoimmune disease, in which natural body substances are recognized as foreign by the immune system and antibodies are produced to attack them. Pemphigus vulgaris is characterized by blisters and erosions of the skin and mucous membranes. The disease is usually controlled by large doses of drugs that suppress the immune system. The patients in the case studies presented were previously treated with immunosuppressive drugs, but the disease was resistant to the drug therapy. The condition of the patients after photochemotherapy improved until they no longer had the symptoms of the disease. The way in which photochemotherapy works is not known, but it is thought to work through other means besides suppressing the immune system. Patients did not show increased susceptibility to infections, as is often seen when they are treated with immunosuppressive drugs and which can lead to serious complications and death. Further studies are necessary to test the use of photochemotherapy in the treatment of patients with the autoimmune disease, pemphigus vulgaris. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Skin diseases, Autoimmune diseases, Chemotherapy, Immunosuppressive agents, Pemphigus, Photochemotherapy, Phototherapy

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The hazards of misguided compassion

Article Abstract:

Pressure to speed up the testing process for drugs used to treat AIDS may sometimes cause more harm than good. The effectiveness and safety of new drugs is usually rigorously tested before they are released. The lack of a preventive vaccine or cure for AIDS has resulted in the early release of several different drugs. Another change is the use of non-randomized research studies. In this type of study, patients may choose the drugs with which they are treated. A research study compared the effectiveness of zalcitabine to that of zidovudine (AZT) in patients who were previously treated with zidovudine. The number of participants in this study was one third the number originally planned. The small size of the study made it difficult to compare or evaluate the effectiveness of zalcitabine and zidovudine.

Editorial, Laws, regulations and rules, Social policy, Drug therapy, United States. National Institutes of Health, Antiviral agents, AIDS (Disease), United States. Food and Drug Administration

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