mycophenolic-acid and Eczema

Originally used to treat psoriasis nearly three decades ago, mycophenolic acid, reformulated as mycophenolate mofetil (MMF), has been rediscovered by the world of dermatology. As a relatively well-tolerated immunosuppressive used in organ transplant recipients, MMF has recently been reported to show promise for several dermatologic conditions, including psoriasis, pemphigus vulgaris, pyoderma gangrenosum, bullous lichen planus, and even connective tissue diseases such as lupus erythematosus and dermatomyositis. Although not intended to be exhaustive, this review discusses MMF with regard to its basic pharmacology, its side effects, and its reported efficacy in a variety of dermatologic indications. Relevant literature was retrieved by a Medline search combining the terms "mycophenolate" or "mycophenolic acid" and "skin" or "skin disease" or a number of specific conditions ("psoriasis", "dermatitis", "eczema", "pemphigoid", "pemphigus", "vasculitis", "pyoderma gangrenosum", "Crohn's disease", "graft-versus-host disease", "lichen planus"). As MMF has only been recently re-introduced for dermatologic application, the nature of much of the literature is admittedly that of case reports or case series. Nevertheless, the results are sufficiently promising to warrant further larger, control studies.

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Eczema; Female; Graft vs Host Disease; Humans; Lichen Planus; Male; Mycophenolic Acid; Pregnancy; Psoriasis; Pyoderma Gangrenosum; Randomized Controlled Trials as Topic; Risk Assessment; Skin Diseases; Skin Diseases, Vesiculobullous; Treatment Outcome

The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This first part of the guideline includes general information on its scope and purpose, the health questions covered, target users and a methods section. It also provides guidance on which patients should be treated with systemic therapies, as well as recommendations and detailed information on each systemic drug. The systemic treatment options discussed in the guideline comprise conventional immunosuppressive drugs (azathioprine, ciclosporin, glucocorticosteroids, methotrexate and mycophenolate mofetil), biologics (dupilumab, lebrikizumab, nemolizumab, omalizumab and tralokinumab) and janus kinase inhibitors (abrocitinib, baricitinib and upadacitinib). Part two of the guideline will address avoidance of provocation factors, dietary interventions, immunotherapy, complementary medicine, educational interventions, occupational and psychodermatological aspects, patient perspective and considerations for paediatric, adolescent, pregnant and breastfeeding patients.

Topics: Adolescent; Azathioprine; Child; Cyclosporine; Dermatitis, Atopic; Eczema; Humans; Immunosuppressive Agents; Mycophenolic Acid

Chronic dermatitis that is refractory to topical therapy poses a difficult treatment problem. Many patients are corticosteroid dependent. Mycophenolate mofetil (MMF) is a systemic B- and T-cell inhibitor that has some effect on delayed-type hypersensitivity. DESIGN, SETTING, INTERVENTIONS: In this open-label study conducted in a university-affiliated private practice setting, 16 patients with chronic and refractory eczema of three months duration or longer were enrolled consecutively into one of three cohorts based on dosage of MMF: five at 1 g/d, six at 1.5 g/d and five at 2.0 g/d. Patients in each cohort were allowed to increase dosage to a maximum of 3 g/d during the study. The authors evaluated the improvement of eczema and the presence of side effects over a 34-week period. Trends in patient and investigator global assessments were analyzed with the fitting of models using generalized estimating equations (GEE).. To determine the efficacy and safety of mycophenolate mofetil (MMF) in the treatment of chronic and refractory eczema.. Twelve of 16 patients improved by patient global assessment and 14 of 16 patients improved by investigator global assessment during the study. Three patients cleared completely and six patients were almost clear. MMF was well-tolerated. One patient experienced a serious adverse event (pancreatic cancer), early in the study, while on therapy. This patient had dermatitis that improved, but pruritus that was out of proportion to exam and a further workup to evaluate newly elevated liver functions after study initiation revealed the pancreatic cancer.. Mycophenolate mofetil is an effective and well-tolerated treatment for some patients with chronic dermatitis.

Topics: Body Surface Area; Chronic Disease; Eczema; Humans; Immunosuppressive Agents; Mycophenolic Acid