Cyclosporine A에 의한 치은과증식의 형태학적 특성과 기전 및 치료

Abstract

Purpose: Cyclosporine A is an immunosuppressant drug that is widely used to reduce mortality and morbidity from graft-versus-host disease. Gingival overgrowth is a common adverse effect caused by cyclosporine A. However, the exact mechanism is not fully elucidated. The aim of this study is to understand the mechanism, clinical/histological characteris of cyclosporine A induced gingival overgrowth and the treatment. Material and Methods: Four journals on cyclosporine A induced gingival overgrowth were published from the Department of Periodontology, College of Dentistry, Yonsei University from 2000 to 2003. The authors reviewed these articles systematically to answer the following question: “What is the mechanism and characteristics of cylosporine A induced gingival overgrowth? And how can it be treated?” Results: Histological, in vivo, in vitro and Azithromycin administration analysis were performed to elucidate the histological characteristics, mechanism of gingival enlargement and proper treatment options. Conclusion: The cause of gingival overgrowth is multifactorial including administration of Cyclosporine A, gingival inflammation and genetic disposition. In histological view, increased amount of extracellular matrix, a number of fibroblasts and multilayered epithelial layer were observed. Cyclosporine A prevents influx of Ca2+ ions and inhibit phagocytosis of collagen to reduce collagen degradation. Maintaining of oral hygiene and regular check up should be encouraged. And surgical excision is considered as a treatment of choice. However, Cyclosporine A induced gingival overgrowth is a condition of collagen accumulation that can be treated by Azithromycin therapy.