Which medications are used in the treatment of eosinophilic fasciitis (EF)?

Updated: Dec 24, 2020
  • Author: Peter M Henning, DO; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Multiple additional therapeutic agents have been used as disease-modifying or steroid-sparing agents in persistent or steroid-resistant cases of eosinophilic fasciitis. It should be noted that there is no general consensus with regard to the best agent for this type of disease. Treatment numbers are generally small, and controlled trials are lacking. [33, 61, 62, 63, 64]

Case reports detail the use of multiple additional agents, including antihistamines, cimetidine, hydroxychloroquine, chloroquine, azathioprine, cyclosporine, dapsone, infliximab, tacrolimus, methotrexate, D-penicillamine, griseofulvin, ketotifen, and alpha-interferon, with varying rates of response. Some data suggest that other anti–tumor necrosis factor (TNF)–alpha agents may also be beneficial. [58]

One study reviewed the treatment modalities used in 32 adult patients with biopsy-proven eosinophilic fasciitis. All patients received corticosteroids as a first-line therapy. Fifteen patients (47%) received methylprednisolone pulses at treatment initiation, and 14 patients (44%) received an immunosuppressive agent, usually methotrexate (86%), as a second-line therapy. There was complete remission in 69% of patients; remission with disability in 19%; and failure in 12%. A poor outcome was associated with a delay in diagnosis greater than 6 months and lack of methylprednisolone pulses. [65]

In a review of 63 patients with eosinophilic fasciitis, Wright and colleagues reported a higher rate of complete response in patients treated with the combination of corticosteroids and methotrexate (21 of 33 patients), compared with other treatment combinations, corticosteroids only, or treatment without corticosteroids. [6]

Successful treatment of eosinophilic fasciitis with mycophenolate mofetil (MMF) has been reported. In the study that included 14 patients, complete clinical response was achieved in 8 patients (57%) and partial clinical response in 5 patients (36%). [66]  


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