壊疽性膿皮症に対するアフェレシス : 顆粒球吸着療法と白血球吸着療法の有用性と問題点(<特集>皮膚疾患とアフェレシス)

概要

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Pyoderma gangrenosum, an intractable skin disease characterized by sterile skin ulcerations, shows histologically a dense neutrophil infiltration throughout the dermis. It is occasionally associated with underlying systemic diseases such as ulcerative colitis, Crohn's disease, aortitis syndrome and rheumatoid arthritis. Although systemic glucocorticoids and immunosuppressive agents are effective in pyoderma gangrenosum patients either with or without associated systemic diseases, there are some cases resistant to these therapies. Granulocyte and monocyte adsorption apheresis (GCAP) and leukocytapheresis (LCAP), apheresis designed to remove the pathogenic neutrophils, have recently shown remarkable effects on ulcerative colitis and also on pyoderma gangrenosum. There has been reported efficacy on pyoderma gangrenosum in 15 cases treated with GCAP and 6 cases treated with LCAP since the first case was described in 2002. No adverse effects were observed in any patients. I therefore consider GCAP and LCAP as effective therapies for pyoderma gangrenosum, but there still remain some problems to be solved. Further studies, including a clinical double-blind study to show the effectiveness of GCAP and LCAP therapy in pyoderma gangrenosum and a basic study to elucidate the precise mechanisms of these therapies, are required.
2008-05-31