Cyclosporine‐induced gingival overgrowth—Review

Abstract

Drug-induced gingival overgrowth (DIGO) is an undesirable effect resulting from the therapy of one of the three groups of drugs: phenytoin, calcium channel blockers, and cyclosporine A (CsA). It is caused by a fibrous overgrowth leading to gingivitis, periodontitis, and even tooth loss. Possible consequences include tooth decay worsening, pain and difficulty in eating, bleeding gums, and bad breath. The pathomechanism of the hypertrophy is unknown, but there is a correlation between insufficient oral hygiene and the severity of this phenomenon. The gender and age predilection of gingival hyperplasia as a result of CsA therapy is also noticeable. It is most common in children and adolescents of the male sex. The beneficial effect of the removal of tartar and local irritants in reducing the above symptoms has been demonstrated.One of the treatments for DIGO is conventional gingivectomy. The paper is a review article about cyclosporine-induced gingival hyperplasia.

Epithelial-to-mesenchymal transition, inflammation, subsequent collagen production, and reduced proteinase expression cooperatively contribute to cyclosporin-A-induced gingival overgrowth development

“…Drug-induced gingival overgrowth (DIGO) is caused by certain medications, such as the immunosuppressive drug cyclosporin-A (CsA), antihypertensive Calcium-channel blockers, and the antiepileptic drug phenytoin ( Subramani et al, 2013 ; Sharma et al, 2020 ; Fang and Tan, 2021 ; Chojnacka-Purpurowicz et al, 2022 ). Although several mechanisms underlying the pathogenesis of these side effects have been proposed, many previous studies have focused on single factors, such as enhanced matrix production, the involvement of inflammation, and reduced matrix degradation; however, they have not explored the combination and cooperation of all these events at the molecular level ( Nishimura et al, 2002 ; Kuo et al, 2012 ; Subramani et al, 2015 ; Drozdzik A and Drozdzik M, 2023 ).…”

Cyclosporine-Induced Gingival Hyperplasia in a Patient With Lichen Planopilaris: Misfortunes Never Come Singly!

“…DIGO typically begins to develop within the first three months and reaches a plateau between nine and 12 months [ 5 ]. The immunosuppressive drug cyclosporine A (CsA), a calcineurin inhibitor, has revolutionized transplantology [ 6 ]. The decision to begin CsA therapy should be based on a risk-benefit analysis [ 6 ].…”

“…The immunosuppressive drug cyclosporine A (CsA), a calcineurin inhibitor, has revolutionized transplantology [ 6 ]. The decision to begin CsA therapy should be based on a risk-benefit analysis [ 6 ]. In cases of severe liver damage, severe and uncontrolled hypertension, malignant neoplasms, and concurrent use of psoralen plus ultraviolet A (PUVA), the use of CsA is not indicated under any circumstances [ 6 ].…”

“…The decision to begin CsA therapy should be based on a risk-benefit analysis [ 6 ]. In cases of severe liver damage, severe and uncontrolled hypertension, malignant neoplasms, and concurrent use of psoralen plus ultraviolet A (PUVA), the use of CsA is not indicated under any circumstances [ 6 ]. The main oral manifestation of CsA is gingival enlargement and hypertrophy, which may lead to pseudo pockets, gingivitis, periodontitis, and tooth loss [ 7 ].…”

Health-related Quality of Life After Liver Transplantation—An Important Goal, but One Definition (or Size) Does Not Fit All

“…For people taking care of transplant patients, the most important word in the previous sentence is “likely”—most, but not all, patients will not experience diminished HRQOL related to immunosuppression choice, but there are circumstances in which immunosuppression choice negatively impacts HRQOL. A patient taking cyclosporine who has marked gingival hyperplasia, 2 one taking tacrolimus who develops significant tremor or other central nervous system dysfunctions, 3 or one taking mycophenolate who develops pancytopenia would fall into this category and would most likely score poorly on any of the standard HRQOL or fatigue measures. A medication change might substantially improve the score for affected patients.…”