tacrolimus and Erythema

Discoid lupus erythematosus (DLE) is a most well-known clinical variation of chronic cutaneous lupus erythematosus inside the spectrum of lupus erythematosus (LE). Cutaneous trauma remains a significant and peculiar causative factor for DLE.. We present a case wherein the patient demonstrated unilateral distribution of DLE on a clinically normal appearing occult facial scald of edible oil, representing Koebner phenomenon (KP) i.e. occurrence of a new skin disease at the site of an unrelated and already healed one.. The 53 years old female patient was unique because she experienced DLE on the nasal back.. The injury was totally settled following a month treatment of oral hydroxychloroquine and topical 0.03% tacrolimus ointment. After three months, she encountered an accidental edible oil scald on the right upper cheek. Several small vesicles appeared on a soybean-sized erythema base with a burning sensation.. We review the literature and conclude by discussing important histologic highlights to think about while endeavoring to perceive the fundamental character and pathogenicity of such sores.

Topics: Burns; Erythema; Female; Humans; Hydroxychloroquine; Lupus Erythematosus, Discoid; Middle Aged; Tacrolimus

Erythema dyschromicum perstans (EDP) is a cosmetically distressing, acquired pigmentary disorder of unknown etiology for which few successful therapies exist. Herein, we present the successful use of non-ablative fractional photothermolysis in combination with topical tacrolimus ointment.. A 35-year-old female with biopsy-confirmed EDP underwent a series of fractionated non-ablative treatment sessions utilizing the 1,550 nm erbium-doped fiber laser in combination with topical tacrolimus ointment over a period of 5 months.. The patient's EDP improved by greater than 75% and results were maintained at the 8-month follow-up visit.. The combination of non-ablative fractional photothermolysis and topical tacrolimus ointment is a potential safe and effective therapeutic option for erythema dyschromicum perstans. Additional prospective, comparative studies are warranted. Lasers Surg. Med. 49:60-62, 2017. © 2016 Wiley Periodicals, Inc.

Topics: Administration, Topical; Adult; Biopsy, Needle; Combined Modality Therapy; Erythema; Esthetics; Female; Follow-Up Studies; Humans; Immunohistochemistry; Lasers, Solid-State; Lichenoid Eruptions; Low-Level Light Therapy; Patient Satisfaction; Severity of Illness Index; Tacrolimus; Treatment Outcome

Annular erythema has been recognized to be a specific, cutaneous manifestation associated with Sjögren's syndrome. Based on a search of the literature up to 2007, annular erythema with Sjögren's syndrome (AESS) preferentially occurs in Asian but not in Western populations. However, the precise clinical course and standard regimen for the management of AESS have remained obscure, primarily because of its rare occurrence in Western populations and the fact that most Asian cases are isolated reports. In this study, 28 cases of AESS from our department and 92 cases distilled from the literature were enrolled in a retrospective study to evaluate the clinical characteristics and most desirable management of this skin manifestation in Sjögren's syndrome. We found that 75% of all cases with AESS were positive for both anti-SSA and anti-SSB antibodies. Multiple therapeutic options are available to treat AESS, including oral steroids. Several anti-malaria drugs or tacrolimus ointment have also been reported to be effective against AESS. AESS is a distinct clinical entity, and a small dose of prednisolone (approx. 10 mg) is sufficient to control diseases activity, except in some cases with systemic manifestations, and this treatment has a more rapid clinical effect than topical steroids.

Topics: Administration, Oral; Administration, Topical; Anti-Inflammatory Agents; Antimalarials; Asian People; Dose-Response Relationship, Drug; Erythema; Humans; Prednisolone; Sjogren's Syndrome; Tacrolimus

Combination of suplatast tosilate with tacrolimus ointment was reported to reduce the dose of tacrolimus ointment with maintained treatment efficacy for refractory facial erythema in atopic dermatitis (AD), however these were only case-controlled studies and the number of cases was not sufficiently large. Thus, the efficacy of a combination therapy of tacrolimus ointment and suplatast tosilate for treating AD including refractory facial erythema was investigated using a method of meta-analysis on the basis of published papers collected by database search.. We searched the literature on the efficacy of a combination of topical tacrolimus and suplatast tosilate for refractory facial erythema in patients with adult atopic dermatitis, and related data were collected for meta-analysis.. Our meta-analysis study showed that suplatast/tacrolimus combination therapy revealed better improvement in skin symptom scores and significantly decreased the dose of tacrolimus compared with topical tacrolimus monotherapy. In addition, a significantly greater number of patients could stop using tacrolimus ointment by using the combination with suplatast tosilate than by tacrolimus monotherapy for refractory facial erythema.. The combination therapy with suplatast tosilate decreased the effective dosage of tacrolimus ointment supporting use of the combination therapy for refractory facial erythema.

Topics: Adult; Anti-Allergic Agents; Arylsulfonates; Dermatitis, Atopic; Drug Therapy, Combination; Erythema; Face; Female; Humans; Immunosuppressive Agents; Male; Sulfonium Compounds; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Combined Modality Therapy; Erythema; Female; Humans; Lasers, Excimer; Male; Middle Aged; Tacrolimus; Vitiligo

The aim of the present study was to evaluate the efficacy and safety of narrowband UVB (NB-UVB) compared with tacrolimus ointment 0.1% in patients with bilateral vitiligo.. In this comparative study, four groups of patients were randomized. Each group was composed by 12 patients with bilateral vitiligo; in each group, every patient was irradiated with NB-UVB (length: 311 nm) twice a week for 9 months and applied tacrolimus ointment 0.1% twice a day on the other area in the same period. Before starting therapy and after 3, 6 and 9 months of therapy, a clinical and photographic evaluation of percentage of repigmentation was performed and Dermatology Life Quality Index Questionnaire was fulfilled.. A repigmentation at least partial occurred in 71% of patients after 36 weeks of treatment with tacrolimus ointment 0.1%; in the whole sample, 14 patients (29%) showed no repigmentation at all, with 2 of them discontinuing the therapy because of side effects (erythema and folliculitis-like manifestations). A homogeneous repigmentation at least partial occurred in 69% of patients after 36 weeks of treatment with NB-UVB; in the whole sample 15 patients (31%) showed no repigmentation at all, with 1 of them discontinuing the therapy because of side effects.. The present study confirmed that the efficacy of NB-UVB phototherapy in vitiligo is comparable to tacrolimus ointment 0.1% therapy. On the basis of our study, we may suggest tacrolimus ointment 0.1% as an alternative to NB-UVB therapy for treating vitiligo.

Topics: Adolescent; Adult; Aged; Child; Epidermis; Erythema; Folliculitis; Humans; Immunosuppressive Agents; Melanocytes; Middle Aged; Prospective Studies; Skin Pigmentation; Surveys and Questionnaires; Tacrolimus; Ultraviolet Therapy; Vitiligo; Young Adult

The skin barrier, located in the stratum corneum, is influenced mainly by the lipid and protein composition of this layer. In eczematous diseases impairment of the skin barrier is thought to be of prime importance. Topical anti-inflammatory drugs and emollients are the most widely used eczema treatments. The aim of this study was to examine the effects of topically applied corticosteroid, tacrolimus and emollient on stratum corneum lipids and barrier parameters. Nineteen healthy volunteers participated in the study. Both forearms of the subjects were divided into four areas, which were treated twice daily for one week with betamethasone, tacrolimus, emollient, or left untreated, respectively. After one week each area was challenged with a 24 h sodium lauryl sulphate patch test. The lipids were collected using the cyanoacrylate method and evaluated by high performance thin layer chromatography. For evaluation of the skin barrier, transepidermal water loss, erythema and electrical capacitance were measured. The ceramide/cholesterol ratio was increased in betamethasone- (p = 0.008) and tacrolimus-treated (p = 0.025) skin compared with emollient-treated skin. No differences in ceramide subgroups were found between treatment regimes. Pretreatment with betamethasone (p = 0.01) or with tacrolimus (p = 0.001) causes a decreased inflammatory response to sodium lauryl sulphate compared with emollient. In conclusion, treatment with betamethasone and tacrolimus has a positive effect on the ceramide/cholesterol ratio and susceptibility to irritant reaction compared with an emollient.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Betamethasone; Ceramides; Cholesterol; Chromatography, High Pressure Liquid; Denmark; Dermatitis, Irritant; Electric Capacitance; Emollients; Erythema; Female; Forearm; Humans; Immunosuppressive Agents; Male; Middle Aged; Skin; Skin Irritancy Tests; Sodium Dodecyl Sulfate; Tacrolimus; Time Factors; Water Loss, Insensible; Young Adult

Steroid-induced rosacea-like eruption is characterized by facial rosacea-like dermatitis in patients that have been treated with topical steroids for relatively long periods.. To evaluate the efficacy and tolerability of 1% pimecrolimus topical cream for steroid-induced rosacea-like eruption.. In an open-label pilot study, 40 patients were enrolled and instructed to apply 1% pimecrolimus cream twice daily for 6 weeks. Patients were evaluated by a rosacea clinical score, investigator's global assessment, overall erythema severity, and tolerability at weeks 0, 2, and 6.. In 35 patients, the rosacea clinical score decreased significantly from 16.0+/-4.3 at baseline to 8.1+/-3.3 at week 2 and 4.2+/-2.5 at week 6 (P<0.0001). Investigator's global assessment was 4.1+/-1.1 (baseline), then decreased to 1.4+/-0.8 (week 2) and 0.5+/-0.6 (week 6) (P<0.0001). By week 6, 48.6% of the patients were clear. Overall erythema severity was 2.4+/-0.7 (baseline), 0.9+/-0.4 (week 2), and 0.3+/-0.4 (week 6) (P<0.0001). Cutaneous adverse events (local burning, stinging, and itching) occurred in 17.5%.. Pimecrolimus cream might be efficacious, safe, and well tolerated for steroid-induced rosacea-like eruption. The small sample size and open label nature of this study is its limitation. Further double-blind, vehicle-controlled studies are needed.

Topics: Administration, Cutaneous; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Calcineurin Inhibitors; Dermatologic Agents; Drug Eruptions; Erythema; Facial Dermatoses; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Satisfaction; Pilot Projects; Rosacea; Safety; Tacrolimus; Telangiectasis; Treatment Outcome

To evaluate the efficacy of the novel topical immune modulator tacrolimus in chronic uninfectious otherwise therapy-resistant external otitis (EO).. Prospective clinical study.. There were 53 patients aged 5 to 83 years. An ear wick containing 0.1% tacrolimus ointment (Protopic) was inserted into the external auditory canal every 2nd to 3rd day. Altogether, the wick was changed three times. The pre-, intra- and posttherapeutic state of the clinical parameters otalgia, edema, otorrhea, erythema, pruritus, and desquamation was rated by means of a 6-point score system. Treatment efficiency was evaluated on the basis of follow-up investigations at 3-month intervals, a standardized findings sheet, and photograph documentation.. The short-term results showed a clear improvement in 85% of the patients and significant reductions of the severity levels for all clinical parameters investigated (P < .001). Concerning the long-term results, a one-time treatment cycle led to complete healing in 46% of the patients throughout a follow-up of 10 to 22 months. Of the patients, 54% had recurrent EO events with significantly extended mean symptom-free intervals. Reapplied tacrolimus treatment patterns attenuated the relapsing course of disease and significantly reduced the number of EO episodes. Within the observation period, no relevant side effects were observed, except for a local feeling of heat, occasional skin burning, and itching.. The topical application of 0.1% tacrolimus ointment in the outer ear canal appears to be an effective and well-tolerated new option in corticosteroid-free treatment of chronic therapy-resistant EO.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Otorrhea; Child; Child, Preschool; Drug Resistance, Bacterial; Earache; Edema; Erythema; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Middle Aged; Otitis Externa; Otoscopy; Prospective Studies; Pruritus; Tacrolimus; Treatment Outcome

Pimecrolimus cream 1% has shown to be effective in patients with a variety of inflammatory cutaneous disorders. And it might be a useful modality in the treatment of seborrheic dermatitis. This prospective study was aimed at assessing the efficacy and tolerability of pimecrolimus cream 1% in the treatment of facial seborrheic dermatitis. Twenty patients were instructed to apply pimecrolimus cream 1% for 4 consecutive weeks. Assessment of the disease severity was performed at baseline and at week 1, 2, and 4. Clinical assessments of erythema, scaling, and pruritus were measured using a 4-point scale (0-3). Global assessments of the disease severity by patients and investigators were performed at each visit. Mean clinical scores of erythema, scaling, and pruritus significantly improved by 87.4%, 91.9%, and 91.5% respectively at week 4 (p<0.001). Improvements in the global assessment of disease severity determined by patients and investigators also showed excellent results. No specific adverse events other than transient burning and tingling sensations were noted. The relapse of facial seborrheic dermatitis was mostly observed between 3 to 8 weeks after the discontinuation of pimecrolimus. We suggest that the topical application of pimecrolimus cream 1% can be an effective and safe alternative for treatment of facial seborrheic dermatitis.

Topics: Adult; Aged; Dermatitis, Seborrheic; Erythema; Face; Female; Follow-Up Studies; Humans; Korea; Male; Middle Aged; Severity of Illness Index; Tacrolimus; Time Factors; Treatment Outcome

Tacrolimus is an immunosuppressive drug that has proved effective in the treatment of psoriasis when administered systemically. Topically, it seems only useful in thin psoriasis plaques located on the face, genitalia, and intertriginous areas. We present an open-label clinical trial to test the efficacy of 0.1% tacrolimus ointment in patients with psoriasis on the face, intertriginous areas, both, and in corporal plaques. Efficacy was assessed with the evaluation of erythema, desquamation, infiltration, reduction of the PASI, and reduction of itching. A total of 15 patients were enrolled in the study. In all the localizations evaluated, each of the signs (erythema, desquamation, and infiltration) showed a statistically significant improvement when compared to the baseline (p < .001). Itching also improved rapidly. PASI was also reduced from a mean of 12 at baseline to 2.2 at the end of the study. Of the 15 patients, only 2 experienced an adverse effect (13%), which was described as a warm sensation in facial lesions which was transient and self-limited. In conclusion, tacrolimus ointment may be an alternative to classical options for the treatment of psoriasis, not only for intertriginous, genital, and facial areas, but also for corporal plaques without occlusion, with good tolerance.

Topics: Adult; Aged; Aged, 80 and over; Elbow; Erythema; Facial Dermatoses; Female; Genitalia; Humans; Immunosuppressive Agents; Intertrigo; Lumbosacral Region; Male; Middle Aged; Ointments; Psoriasis; Severity of Illness Index; Skin; Tacrolimus; Treatment Outcome

A dose- and vehicle-controlled study on the pretreatment and posttreatment effect of 0.1% tacrolimus ointment on erythema induced by solar-simulated ultraviolet (UV) radiation was performed. Surprisingly, comparisons of clinical erythema scores and colorimetric data obtained 24 and 72 hours after UV exposure did not reveal significant differences between the control, tacrolimus, and vehicle preirradiation and postirradiation treated sites (P > .05). Our data strongly indicate that topical tacrolimus neither prevents nor abolishes UV-induced erythema in a clinical meaningful degree.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Dose-Response Relationship, Drug; Erythema; Female; Humans; Male; Middle Aged; Tacrolimus; Treatment Failure; Ultraviolet Rays

Topics: Adjuvants, Immunologic; Administration, Cutaneous; Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Erythema; Facial Dermatoses; Female; Humans; Tacrolimus; Treatment Outcome; Wine

To evaluate pimecrolimus cream 1% and tacrolimus ointment 0.03% in pediatric patients with moderate atopic dermatitis (AD).. 141 patients (aged 2-17 years) were randomized to treatment with pimecrolimus cream 1% (n=71) or tacrolimus ointment 0.03% (n=70) twice daily for 6 weeks.. At day 4, local, application-site reactions were less common and of shorter duration with pimecrolimus than with tacrolimus. Incidence of erythema/irritation was 8% (6/71) with pimecrolimus compared with 19% (13/70) with tacrolimus (P=.039). Fewer patients receiving pimecrolimus (0%, 0/6) experienced erythema/irritation lasting >30 minutes, compared with those receiving tacrolimus (85%, 11/13; P <.001). Fewer patients reported itching with pimecrolimus (8%; 6/71) than with tacrolimus (20%; 14/70; P=.073). Incidence of warmth, stinging, and burning was similar in both groups; however, reactions lasting >30 minutes were fewer with pimecrolimus (0%, 0/14) than with tacrolimus (67%, 8/12; P <.001). More patients receiving pimecrolimus rated ease of application as 'excellent' or 'very good', compared with tacrolimus (76% vs 59%, respectively; P <.020). Efficacy was similar in both groups at day 43. Both treatments were generally well tolerated with no unexpected adverse events.. Pimecrolimus cream 1% had better formulation attributes and local tolerability than tacrolimus ointment 0.03% while providing similar efficacy and overall safety in pediatric patients with moderate AD.

Topics: Adolescent; Child; Child, Preschool; Dermatitis, Atopic; Dermatitis, Irritant; Dermatologic Agents; Drug Administration Schedule; Drug Combinations; Erythema; Female; Humans; Male; Ointments; Patient Satisfaction; Pruritus; Tacrolimus

Seborrhoeic dermatitis is a chronic inflammatory disease with remissions and exacerbations, characterized by erythema, scaling and pruritus primarily on the face, scalp and chest. Corticosteroids and antifungals are the mainstay of therapy. However, chronic use of corticosteroids is associated with side-effects such as skin atrophy and telangiectasia. Pimecrolimus, an inhibitor of calcineurin, has been used successfully in one patient with seborrhoeic dermatitis.. The objective of this randomized open-label clinical trial was to compare the efficacy and tolerability of pimecrolimus in comparison with a potent corticosteroid (betamethasone 17-valerate) in the treatment of seborrhoeic dermatitis.. Twenty patients with seborrhoeic dermatitis were included in this study, 11 patients in the pimecrolimus 1% cream group and nine patients in the betamethasone 17-valerate 0.1% cream group. Patients were instructed to use a thin layer of the study products twice daily at the lesional area and to discontinue treatment as soon as symptoms were absent. Clinical measures assessed were erythema, scaling and pruritus which were evaluated using a four-point scale (0-3).. Both pimecrolimus and betamethasone were highly effective in the treatment of seborrhoeic dermatitis. Betamethasone reduced all three parameters, erythema, scaling and pruritus, faster than pimecrolimus, but the differences in reduction were not statistically significant. Relapses were observed more frequently and were more severe with betamethasone than with pimecrolimus. Moreover, pruritus was not observed after discontinuation of treatment from day 15 and beyond in the pimecrolimus group, whereas it was reported in most patients of the betamethasone group. This difference was statistically significant.. It appears that pimecrolimus, a nonsteroidal topical treatment, may be an excellent alternative therapeutic modality for treating seborrhoeic dermatitis.

Topics: Administration, Cutaneous; Adult; Betamethasone; Calcineurin Inhibitors; Dermatitis, Seborrheic; Dermatologic Agents; Erythema; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pruritus; Recurrence; Severity of Illness Index; Tacrolimus; Treatment Outcome

The aim of this study was to evaluate the ability of topical tacrolimus 0.1% under occlusion for 48 h to suppress nickel-elicited allergic contact dermatitis in a randomized, petrolatum- and mometasone furoate 0.1% ointment-controlled double-blind, intra-individual study which included 28 women volunteers. 3 closed patch tests (Finn Chambers on Scanpor, Epitest Ltd Oy, Tuusula, Finland) containing 0.1 ml of 5% nickel sulfate in petrolatum were applied on day 0. After removal on day 2, the study compounds were applied under occlusion for 48 h. The eczema reaction and the degree of erythema were evaluated clinically and by reflectance spectrophotometry at days 4 and 7, respectively. Mean visual scores corresponding to petrolatum-treated sites were significantly higher than those corresponding to both mometasone furoate and tacrolimus at days 4 (P < 0.001) and 7 (P < 0.001). In both tacrolimus- and mometasone furoate-treated sites, there was a significant decrease in visual scores with time (P < 0.001) from day 2 to day 7, and the corresponding mean decreases in scores were 0.73 and 1.04, respectively. The difference between both was 0.30 in favour of tacrolimus (95% confidence intervals, -0.04 and 0.65), although this did not reach statistical significance (P = 0.084). Mean erythema index values were similar at day 2. Significant differences among treatment sites were seen at days 4 (P < 0.001) and 7 (P < 0.001). The decrease was significantly more pronounced on day 7 in patches where tacrolimus had been supplied (P < 0.5). This method might provide useful means to compare different concentrations and/or presentations of tacrolimus or other calcineurin inhibitors and topical anti-inflammatory agents.

Topics: Administration, Topical; Adult; Anti-Allergic Agents; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Double-Blind Method; Emollients; Erythema; Female; Humans; Immunosuppressive Agents; Irritants; Middle Aged; Mometasone Furoate; Nickel; Ointments; Patch Tests; Petrolatum; Pregnadienediols; Spectrophotometry; Tacrolimus; Time Factors

Tacrolimus (formerly FK 506) is an immunosuppressive drug that works by inhibiting calcineurin, a calcium-dependent protein phosphatase required for immune function. Tacrolimus has been shown to be effective topically in atopic dermatitis and systemically in psoriasis and graft-vs-host disease (GVHD). However, its efficacy in treating cutaneous GVHD when applied topically has not been reported.. To assess the therapeutic efficacy of 0.1% tacrolimus ointment on chronic cutaneous GVHD in patients with symptoms refractory to systemic corticosteroid therapy.. Tacrolimus ointment effectively treated pruritus and/or erythema in 13 (72%) of 18 patients with chronic GVHD. Responding patients had a rapid effect within several hours to days. Effectiveness was measured by means of patient report, results of physical examination, side-by-side comparisons of tacrolimus vs a vehicle control, and temporal flares of the cutaneous symptoms of the disease in the context of stopping tacrolimus ointment therapy. Because of the progression of GVHD and in 2 cases, loss of drug efficacy, all patients eventually went on to receive more aggressive treatment, including increases in steroid dosage, psoralen-UV-A therapy, and extracorporeal photopheresis.. This case series suggests that tacrolimus ointment has efficacy in treating the erythema and pruritus of steroid-refractory, chronic cutaneous GVHD in most patients. The rapid response of tacrolimus ointment may provide a useful therapeutic bridge to systemic therapies that have slower onset, such as psoralen-UV-A therapy or extracorporeal photopheresis.

Topics: Adult; Bone Marrow Transplantation; Chronic Disease; Erythema; Female; Graft vs Host Disease; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Pruritus; Skin Diseases; Tacrolimus; Treatment Outcome

Topics: Acne Vulgaris; Atrophy; Cicatrix; Connective Tissue Diseases; Erythema; Humans; Tacrolimus; Treatment Outcome

Topics: Erythema; Humans; Infant; Pigmentation Disorders; Skin Diseases, Genetic; Tacrolimus

The external auditory canal (EAC) comprises a special area where erythematous-scaly diseases are located. Among the main dermatoses that can affect EAC seborrheic dermatitis, psoriasis, irritant or allergic contact dermatitis, chronic external otitis (atrial eczematoid dermatitis) and cutaneous lupus should be considered. In this study, 25 consecutive patients were recruited on our dermatological outpatient clinic, 9 men and 16 women, with a clinical diagnosis of localized erythematous-squamous dermatoses in EAC. The mean age was 48.8 years (16-83). The mean time of evolution of the dermatoses was 11.44 months (2-36). Regarding the diagnosis, 14 patients were diagnosed with seborrheic dermatitis (56%), 9 patients with psoriasis (36%), 1 patient with subacute cutaneous lupus (4%), and 1 patient with allergic contact dermatitis to corticosteroids (4%). The indicated treatment was tacrolimus 0.1% and clotrimazole 1% in otic oil, twice a day, for 1 month. The EAC had to be cleaned initially with saline solution impregnated on a swab from the ears. The IGA score and pruritus showed a high results, with important improvement of almost all patients. The satisfaction of the patients obtained with the TSQM-9 questionnaire was 95.2. Retreatment showed an equal efficacy observed during the first treatment period. The efficacy and the absence of side effects with the treatment make this magistral formula an adequate therapeutic option for these dermatoses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Clotrimazole; Ear Canal; Ear Diseases; Erythema; Female; Humans; Male; Middle Aged; Tacrolimus; Young Adult

Intense pulsed light (IPL) is a good option for erythema and telangiectasia of rosacea. Demodex, which is light and heat sensitive, is an important risk of Rosacea. Sometimes, IPL can induce rosacea aggravation. Here, we show two cases of erythema rosacea aggravated as pustule in several hours after IPL. Both cases show high density of Demodex after IPL. Neither of them had photosensitivity, systemic disease, or any other contraindication for IPL. One of the patients received IPL again after Demodex infection relieved and this time there was no inflammation induction. We need to attract more attention to IPL-induced rosacea aggravation and latent Demodex infection may act as a cofactor.

Topics: Adult; Animals; Anti-Bacterial Agents; Biopsy; Erythema; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Intense Pulsed Light Therapy; Middle Aged; Minocycline; Mite Infestations; Retrospective Studies; Rosacea; Skin; Skin Cream; Tacrolimus; Telangiectasis; Treatment Outcome

Topics: Alopecia; Erythema; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents; Infant; Male; Nail Diseases; Tacrolimus; Wiskott-Aldrich Syndrome

Topics: Anti-Inflammatory Agents; Autoantibodies; Dermatomyositis; Drug Eruptions; Early Detection of Cancer; Electromyography; Erythema; Humans; Immunosuppressive Agents; Male; Methotrexate; Methylprednisolone; Middle Aged; Skin; Tacrolimus; Transcription Factors; Treatment Outcome

Transient erythema after alcohol consumption is a side effect of topical tacrolimus use. The clinical picture is characterised by itching, a burning sensation and erythema, often at the site where tacrolimus is applied. The erythema develops shortly after alcohol consumption and disappears after approximately 1 hour.. We are describing a patient who used a 0.1% tacrolimus ointment for periocular eczema and in whom transient erythema developed around the eyes after alcohol consumption.. The symptoms may be caused by the capsaicin-like effects of both tacrolimus and ethanol. Potential inhibition of aldehyde dehydrogenase by tacrolimus may also play a role. Prophylactic treatment with acetylsalicylic acid before alcohol consumption reduces the symptoms.

Topics: Administration, Topical; Alcohol Drinking; Eczema; Erythema; Humans; Immunosuppressive Agents; Ointments; Pruritus; Tacrolimus

Topics: Antibodies, Viral; Drug Substitution; Erythema; Everolimus; Herpesviridae Infections; Herpesvirus 8, Human; Humans; Immunosuppressive Agents; Lung Transplantation; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Sarcoma, Kaposi; Tacrolimus; Thoracic Neoplasms; Tissue Donors; Viremia

Topics: Administration, Cutaneous; Adult; Alcohol Drinking; Calcineurin Inhibitors; Dermatitis, Atopic; Drug Interactions; Erythema; Eyelid Diseases; Facial Dermatoses; Humans; Male; Tacrolimus

Topics: Aged; Erythema; Female; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Middle Aged; Psoriasis; Scalp; Tacrolimus; Treatment Outcome; Vulva

To date, no study has compared the clinical characteristics, malignancy associations, and treatment of dermatomyositis in predominantly Caucasian vs. Asian populations.. This prospective study was conducted to compare clinical characteristics of dermatomyositis, its relationship to malignancy, and treatment between two tertiary medical centers in the USA and Singapore. A total of 19 newly-diagnosed patients in the USA and 15 patients in Singapore were enrolled. Dermatomyositis or amyopathic dermatomyositis were diagnosed based on clinical assessment, skin and muscle biopsies, and muscle testing.. Ninety-five percent of patients in the USA group were of Caucasian descent, while 93% of patients in the Singapore group were of Chinese descent. Both groups were predominantly female. Pruritus was the most common initial symptom reported in both groups, while periungual erythema and Gottron's papules were the most common skin presentations. Heliotrope eruption was more common in the Singapore group, occurring in 80% of patients vs. 32% of patients in the USA group (P = 0.007). Three patients in the Singapore group developed a malignancy, with two of these patients having nasopharyngeal carcinoma. None of the USA patients developed malignancies in a follow- up period of 2-5 years. Immunosuppressive steroid sparing therapy with hydroxychloroquine was more frequently used in Singapore, while topical tacrolimus was more frequently used in the USA.. The clinical presentations of dermatomyositis vary among different ethnic populations. Chinese patients with dermatomyositis have a significant risk for nasopharyngeal carcinoma.

Topics: Adrenal Cortex Hormones; Adult; Aged; Antibodies, Monoclonal, Murine-Derived; Asian People; Bone Density Conservation Agents; Calcium Compounds; Carcinoma; Dermatomyositis; Dietary Supplements; Diphosphonates; Erythema; Female; Humans; Hydroxychloroquine; Immunosuppressive Agents; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Nasopharyngeal Neoplasms; Oxides; Prospective Studies; Pruritus; Rituximab; Singapore; Tacrolimus; Tertiary Care Centers; United States; Vitamin D; White People

Topics: Administration, Topical; Erythema; Female; Humans; Immunosuppressive Agents; Middle Aged; Scleroderma, Localized; Tacrolimus; Treatment Outcome

We investigated clinical factors that affected the clearance of tacrolimus (FK506) administered by continuous drip infusion to children who had received allogeneic hematopoietic SCT. Blood FK506 levels were measured every day in 27 patients in an attempt to adjust the dose to maintain the target range (10-15 ng/mL). Patients who developed engraftment syndrome (ES) and acute GVHD and patients less than 7 years of age showed a higher FK506 clearance calculated from body weight (BW) for 5 or more consecutive days compared with the control groups. A time-course study showed that the occurrence of ES, but not acute GVHD, was related to increased clearance of FK506. When calculated from body surface area (BSA), a significant increase in FK506 clearance was observed in patients with ES, but not in those less than 7 years of age. FK506 clearance was not influenced by CYP3A5, multidrug resistance 1 or ABCG2 genotypes. None of the clinical parameters affected blood FK506 levels. Determination of the FK506 dose on the basis of frequent monitoring of the blood concentration seems to minimize the serious adverse effects induced by the immunosuppressant. It may be more accurate to dose FK506 according to BSA rather than BW for pediatric patients.

Topics: Adolescent; Aging; ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; ATP Binding Cassette Transporter, Subfamily G, Member 2; ATP-Binding Cassette Transporters; Child; Child, Preschool; Cytochrome P-450 CYP3A; Drug Dosage Calculations; Erythema; Female; Fever; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Hypoxia; Immunosuppressive Agents; Infant; Male; Metabolic Clearance Rate; Neoplasm Proteins; Polymorphism, Genetic; Pulmonary Eosinophilia; Syndrome; Tacrolimus; Weight Gain

A 45-year-old woman with personal history of hypertension presented with an erythematous lesion in the neckline for a year and with a progressive growth. A physical examination revealed an annular lesion with erythematous papules in the edge. Histological exam showed phagocytosis of elastic fibers by multinucleated cells compatible with annular elastolytic giant-cell granuloma. The patient did not present any other associated systemic manifestation. Treatment with tacrolimus 0.1 percent ointment was prescribed with a very good response after two months.

Topics: Erythema; Female; Granuloma, Giant Cell; Humans; Immunosuppressive Agents; Middle Aged; Skin Diseases; Tacrolimus

Chronic GVHD (cGVHD) frequently affects the oral cavity. The purpose of this study was to estimate the efficacy of combined topical dexamethasone (DEX) and tacrolimus (TAC) solutions in the management of oral cGVHD. The records of 14 patients with oral cGVHD treated with combined topical DEX/TAC were reviewed retrospectively. Pre-to-post treatment changes in subjective and objective measures were evaluated at a median follow-up of 60 days. Serum TAC levels were examined. Marginal objective improvement was detected at follow-up. The median pre-to-post treatment differences were 0.5 (range, -1 to 1) for erythema score, and 0.5 (range, 0 to 2) for lichenoid score, (P=0.06, 0.07 and 0.02, respectively). Subjective improvement was noted in three of four measures at the follow-up visit. The median differences in pain, sensitivity and dryness scores were 1 (range -1 to 6), 1 (range -3 to 5) and 2.5 (range, -5 to 5), respectively (0-10 scale, P<0.05). Four patients (37%) showed increased serum TAC levels; however, all remained within therapeutic range. In conclusion, combined topical DEX/TAC therapy appears to be effective in reducing symptoms attributable to oral cGVHD. Our data has shown minimal evidence of systemic TAC absorption.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Dexamethasone; Drug Therapy, Combination; Erythema; Female; Graft vs Host Disease; Humans; Immunosuppressive Agents; Lichenoid Eruptions; Male; Middle Aged; Mouth; Pain; Retrospective Studies; Tacrolimus; Treatment Outcome; Young Adult

Topics: Bone Marrow Transplantation; CA-125 Antigen; Carcinoma, Papillary; Erythema; Fatal Outcome; Female; Graft vs Host Disease; Graft vs Tumor Effect; Humans; Leukemia, Myeloid, Acute; Membrane Proteins; Middle Aged; Ovarian Neoplasms; Prednisolone; Tacrolimus

Cutaneous mastocytosis (CM) is a common type of mastocytosis. Current treatment of CM is generally symptomatic. Pimecrolimus has been demonstrated as an effective anti-inflammatory drug for the treatment of inflammatory skin diseases, but whether it treats CM remains unknown.. The murine model of CM was induced by subcutaneous injection of 100 μg/kg recombinant murine stem cell factor (rmSCF) for a total of 17 days in Balb/c mice. Beginning on the 8th day, treatment with pimecrolimus 1% cream or vehicle was performed topically and daily for 10 days. The clinical signs of CM were scored, and pathological analysis was performed with toluidine blue staining and hematoxylin and eosin staining. The in situ apoptotic mast cells (MCs) were studied by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay. The cutaneous histamine level was measured by ELISA.. In the rmSCF-treated mice, the clinical signs of CM, including erythema, wheal after rubbing lesion skins, and increased thickness of skin, were obvious compared to control mice, and were reduced after pimecrolimus treatment. The numbers of cutaneous MCs and neutrophils were significantly greater in mice with CM than in control mice, and pimecrolimus treatment decreased the numbers of MCs but not neutrophils. Extensive apoptosis of cutaneous MCs was observed in pimecrolimus-treated mice. The cutaneous histamine level was elevated in the mice with CM compared with healthy controls, and was lowered after treatment with pimecrolimus.. Pimecrolimus effectively treats CM by reducing the density of cutaneous MCs and the subsequent histamine production through inducing MCs apoptosis.

Topics: Administration, Topical; Animals; Anti-Inflammatory Agents, Non-Steroidal; Apoptosis; Cell Count; Disease Models, Animal; Erythema; Histamine; Humans; Injections, Subcutaneous; Mast Cells; Mastocytosis, Cutaneous; Mice; Mice, Inbred BALB C; Neutrophils; Skin; Stem Cell Factor; Tacrolimus

Atopic dermatitis (AD) is chronically relapsing eczematous skin disorder having significant impact worldwide. Tacrolimus is the drug-of-choice which inhibits T-cell activation resulting in suppression of inflammation. However, despite being effective, most common adverse events of tacrolimus are low-and-variable bioavailability, burning sensation and pruritus at application site, which prompt for development of novel carrier that could effectively target tacrolimus to site-of-action without producing undesirable side-effects. Tacrolimus-loaded lipid-nanoparticles (T-LN) were prepared and optimized. DSC and FT-IR have been employed to study drug-excipient incompatibility and encapsulation of drug in lipid which was further confirmed by (1)H NMR. In vitro studies revealed much higher drug release, skin penetration and enhanced skin accumulation as compared to reference Protopic. In vitro and in vivo occlusion studies demonstrated similar occlusiveness for T-LN and reference however; T-LN showed significantly higher drug levels penetrating into deeper skin layers where dendritic cells responsible for immunopathogenesis of AD mainly reside. In-vivo skin retention demonstrated 3.36, 30.81 and 28.68-times higher stratum corneum, epidermal and dermal levels respectively compared to reference. Visualization of cutaneous uptake in-vivo using CLSM confirmed targeting to deeper skin layers and Draize test showed no skin irritation with PII 0.00. Thus T-LN displayed superior performance, effective skin targeting and improved safety as compared to reference.

Topics: Administration, Cutaneous; Animals; Dermatitis, Atopic; Drug Delivery Systems; Erythema; Rabbits; Rats; Skin Absorption; Swine; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Adult; Alcohol Drinking; Dermatologic Agents; Erythema; Female; Flushing; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Vitiligo

Lichen planopilaris (LPP) is an inflammatory condition of unknown etiology that affects pilosebaceous units, mainly of the scalp, and results in scaring alopecia.. A 51-year-old male presented with a pruritic eruption on the cheek consisting of atrophic macules and erythematous folliculocentric papules.. Biopsy revealed a perifollicular lymphocytic infiltrate and vacuolar degeneration of the dermoepidermal junction consistent with LPP. Many treatment modalities have been utilized, with varying degrees of success. Our patient responded poorly to topical steroids. After nine months of topical tacrolimus therapy, his lesions resolved entirely.. The treatment of our patient demonstrates tacrolimus as a novel topical therapeutic option for patients with LPP.

Topics: Erythema; Facial Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Tacrolimus; Treatment Outcome

A 58-year-old, obese, male, army officer was presented with tinea incognito of the groin masking intertriginous psoriasis. According to his history, he had pruritic, symmetrical erythematous eruption of the groin of 2-month duration that he treated himself by using topical pimecrolimus 1%. This medication had been prescribed for his 8-year son's atopic dermatitis by the paediatrician. Direct examination with potassium hydroxide preparation showed fungal hyphae and Trichophyton rubrum was isolated in culture. This is the second case of topical pimecrolimus induced tinea incognito. We also review the cutaneous disorders that tinea incognito may mimic.

Topics: Diagnosis, Differential; Erythema; Groin; Humans; Immunosuppressive Agents; Male; Middle Aged; Psoriasis; Tacrolimus; Tinea; Trichophyton

Topics: Alcohol Drinking; Erythema; Female; Flushing; Humans; Immunosuppressive Agents; Middle Aged; Tacrolimus

We report on the efficacy of twice daily application of pimecrolimus 1 percent cream in a 48-year-old woman with reticular erythematous mucinosis (REM) syndrome and compare its results with pulsed dye laser (PDL) on the other side of her chest and back. The patient was previously treated by hydroxychloroquine but only a fair response was observed. After application of 5 months of pimecrolimus, the lesions completely resolved and the result was comparable with the other side of her body treated by pulsed dye laser PDL. Topical pimecrolimus and pulsed dye laser appear to be effective and safe treatments for REM.

Topics: Administration, Topical; Biopsy, Needle; Combined Modality Therapy; Erythema; Female; Follow-Up Studies; Humans; Immunohistochemistry; Low-Level Light Therapy; Middle Aged; Mucinoses; Syndrome; Tacrolimus; Treatment Outcome

The aim of this study was to compare the morphologic changes in the gingiva brought about by the administration of cyclosporin and tacrolimus in rats.. The study was conducted on 30 six-week-old male Sprague-Dawley rats, divided into three groups of 10 rats each, for a period of 4 weeks. Group I rats received cyclosporin (30 mg/kg body weight), and group II rats received tacrolimus (1.5 mg/kg body weight), by means of a gavage. Group III served as control and received olive oil alone. Impressions of the mandibular incisal region were made weekly, and stone casts were prepared for measuring morphologic changes of the gingiva.. An increase in the measured gingival dimensions was observed in the test groups as early as week 2 after the commencement of drug administration. Intergroup comparison revealed that the increase in the measured dimensions was greater in group I than group II at the end of 4 weeks.. Cyclosporin and tacrolimus were capable of causing gingival enlargement in Sprague-Dawley rats. However, the magnitude of tacrolimus-influenced gingival enlargement seemed to be comparatively less than cyclosporin.

Topics: Animals; Cyclosporine; Dental Impression Technique; Erythema; Gingiva; Gingival Overgrowth; Gingivitis; Immunosuppressive Agents; Male; Models, Dental; Olive Oil; Plant Oils; Random Allocation; Rats; Rats, Sprague-Dawley; Tacrolimus

Topics: Administration, Topical; Adult; Erythema; Humans; Immunosuppressive Agents; Male; Mouth Diseases; Phototherapy; Psoriasis; Severity of Illness Index; Tacrolimus

Topics: Calcineurin Inhibitors; Dermatologic Agents; Erythema; Humans; Lymphocytosis; Male; Middle Aged; Skin Diseases, Papulosquamous; Tacrolimus

Topics: Adult; Erythema; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Sjogren's Syndrome; Tacrolimus

Topics: Adolescent; Erythema; Humans; Immunosuppressive Agents; Male; Mucinoses; Syndrome; Tacrolimus

To document the clinical experience in the diagnosis and treatment of graft-versus-host disease(GVHD) after liver transplantation.. Clinical course was followed up and laboratory examinations were done in 3 patients with orthotopic liver transplantation (OLT) who developed acute GVHE. The diagnosis depended on clinical manifestations, skin biopsy, HLA typing and PCR short tandem repeat (PCR-STR). Immunosuppressive drugs were transferred and adjusted.. Fever, shin rash, diarrhea and pancytopenia were found within 3 to 8 weeks after liver transplantation. The liver function was normal. CMV antigen (pp65) and EBV antibody (IgM) were negative. The donor's HLA was detected in the host's peripheral blood cells. One female recipient had the donor's Y chromosome microchimerism detected by PCR-STR. All 3 patients died from infection, alimentary tract bleeding, or multiple organ failure in the end.. GVHD is not a rare complication easily misdiagnosed with pessimism out come after liver transplantation.

Topics: Cyclosporine; Erythema; Fatal Outcome; Female; Fever; Graft vs Host Disease; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Pancytopenia; Polymerase Chain Reaction; Prognosis; Skin; Tacrolimus

Annular erythema is an unusual, often idiopathic disorder that tends to respond poorly to topical therapy. Two patients with idiopathic, topical corticosteroid-resistant annular erythema showed prompt clearing of lesions treated with 0.1% tacrolimus ointment and persistence of untreated ones which themselves responded to subsequent treatment. These two cases demonstrate a clear-cut therapeutic response of chronic, topical corticosteroid-resistant annular erythema to topical tacrolimus ointment 0.1% BID. Additional experience with tacrolimus ointment, hopefully in controlled circumstances, should clarify its potential value in treating annular erythema.

Topics: Adult; Erythema; Female; Humans; Immunosuppressive Agents; Middle Aged; Ointments; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Adult; Antibody Formation; Child; Dermatitis, Atopic; Dose-Response Relationship, Drug; Erythema; Humans; Immunity, Cellular; Pruritus; Randomized Controlled Trials as Topic; Tacrolimus

A patient with an allergy to a macrolide antibiotic was given tacrolimus and developed a sudden cutaneous reaction.

Topics: Anti-Bacterial Agents; Cross Reactions; Drug Eruptions; Erythema; Female; Graft vs Host Disease; Humans; Immunosuppressive Agents; Leukemia, Myeloid, Acute; Middle Aged; Tacrolimus

Topics: Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Dermatitis, Atopic; Drug Resistance; Erythema; Facial Dermatoses; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Ointments; Tacrolimus; Time Factors; Treatment Outcome