tacrolimus and Exanthema

The prevalence of atopic dermatitis is increasing, and more than 50% of children with atopic dermatitis go on to develop asthma and allergies. A better understanding of the underlying immune abnormalities of this complex chronic relapsing skin disease is needed. Although the optimal treatment approach remains to be defined, several recent studies suggest a rationale for using topical calcineurin inhibitors as early intervention and adding topical corticosteroids as rescue therapy if needed.

Topics: Adrenal Cortex Hormones; Bacterial Toxins; Child; Child, Preschool; Dermatitis, Atopic; Exanthema; Humans; Ointments; Pruritus; Tacrolimus

Contact dermatitis is a common clinical problem, with prevalent sensitizers being cosmetics, metals, medicines, and plants. Plants of the Toxicodendron species cause allergic contact dermatitis (ACD) in 50% to 70% of the population. Pimecrolimus is an ascomycin macrolactam developed for the treatment of inflammatory skin diseases and approved by the US Food and Drug Administration for atopic dermatitis. There are studies supporting the effectiveness of macrolactams when administered before antigen challenge, but there are no studies describing the effectiveness of these drugs in the treatment of established human ACD.. To investigate the effect of topical pimecrolimus in the treatment of Toxicodendron-induced ACD once rash is evident.. Poison ivy tincture was applied to the bilateral anterior forearms of 12 subjects with Finn Chambers (Allerderm Diagnostic Products, Petaluma, CA). After dermatitis was evident, volunteers treated each arm twice daily with either 1% topical pimecrolimus cream or placebo in a blinded fashion. Outcomes measured were a dermatitis grading score and time to rash and itch resolution.. The median +/- SEM time for rash resolution was 16.55 +/- 1.59 days in the treatment group and 16.27 +/- 1.82 days in the placebo group (P = 0.601). The median time for itch resolution was 4.73 +/- 1.56 days in the treatment group and 4.91 +/- 1.59 days in the placebo group (P = 0.167). The average dermatitis score was 2.26 +/- 0.17 in the treatment group and 2.32 +/- 0.15 in the placebo group (P = 0.62).. The application of topical pimecrolimus is ineffective in the treatment of ongoing Toxicodendron-induced ACD.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Allergic Contact; Dermatitis, Toxicodendron; Dermatologic Agents; Exanthema; Female; Humans; Male; Middle Aged; Pruritus; Severity of Illness Index; Tacrolimus; Time Factors; Treatment Outcome

Cutaneous immune-related adverse events (cirAEs) remain a prevalent and common sequelae of immune checkpoint inhibitor (ICI) therapy, often necessitating treatment interruption and prolonged immune suppression. Treatment algorithms are still poorly defined, based on single-institution case reports without adequate safety assessments, and subject to publication bias.. Data in this registry were collected through a standardized REDCap form distributed to dermatologists via email listserv.. Ninety-seven cirAEs were reported from 13 institutions in this registry. Topical and systemic steroids were the most common treatments used; however, targeted treatment matched to disease morphology was identified at numerous sites. Novel cirAE therapy uses that to our knowledge have not been previously described were captured including tacrolimus for the treatment of follicular, bullous, and eczematous eruptions and phototherapy for eczematous eruptions. Moreover, further evidence of cirAE treatment applications sparsely described in literature were also captured in this study including dupilumab and rituximab for bullous eruptions, phototherapy for lichenoid and psoriasiform eruptions, and acitretin for psoriasiform eruptions, among others. No serious adverse events were reported. Numerous targeted therapeutics including dupilumab, rituximab, and psoriasis biologics, among others, were associated with a cirAE grade improvement of ≥2 grades in every patient treated.. This study suggests that a multi-institutional registry of cirAEs and management is not only feasible but that the information collected can be used to detect, evaluate, and rigorously assess targeted treatments for cirAEs. Further expansion and modification to include treatment progression may allow for sufficient data for specific treatment recommendations to be made.

Topics: Exanthema; Humans; Psoriasis; Rituximab; Skin; Tacrolimus

Tyrosine kinase inhibitors (TKI) are an effective treatment option for chronic myeloid leukemia (CML). The most common associated adverse effects of TKI include thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea. Facial edema is a rare adverse reaction that may cause significant psychological burden. Treatment is life-long in many cases therefore it is vital to have options available to manage these adverse effects.. We present a 70-year-old female with a medical history of CML, diabetes, hypertension, and hypercholesterolemia who presented to our dermatology clinic for chief complaint of worsening edematous facial rash beginning after initiation of dasatinib. We were able to achieve significant improvement with a regimen that allowed her to remain on dasatinib.. We treated the patient with a novel, unreported regimen of topical metronidazole 1% gel to be applied every morning and topical tacrolimus 0.1% ointment to be applied twice daily. She had significant improvement with the treatment and was continued on this topical regimen indefinitely.. Previous reports of treatment options available for TKI-associated facial edema include topical and systemic corticosteroids, which can cause long-term side effects int the context of long-term TKI use. Our patient achieved an acceptable reduction in facial edema and rash with our combination regimen of metronidazole gel and tacrolimus ointment. We present the only such case of successful treatment of facial edema associated with a tyrosine kinase inhibitor. We encourage future studies on the efficacy and safety of this regimen to treat this adverse effect.

Topics: Aged; Antineoplastic Agents; Dasatinib; Edema; Exanthema; Face; Female; Gels; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Metronidazole; Ointments; Protein Kinase Inhibitors; Tacrolimus

Drug-induced hypersensitivity reactions attributed to the immunosuppressive agent tacrolimus after an organ transplant are rare in the literature. We present 3 cases of male adult patients grafted with a cadaveric liver who developed delayed hypersensitivity reactions to tacrolimus in the form of the prolonged-release capsules (Advagraf). Furthermore, the appropriate drug concentration solutions used for allergy testing are proposed.. All patients received a liver transplant (LT) because of cirrhosis of various etiologies. They were immunosuppressed with tacrolimus once daily. Several months after they had been placed on an immunosuppressive regimen with tacrolimus in the form of prolonged-release capsules (Advagraf), the patients presented with delayed hypersensitivity reactions and torturous pruritic rash that affected the whole body and was unresponsive to treatment with oral ursodeoxycholic acid, cholestyramine, or levocetirizine. Allergy testing that was performed by skin prick testing was negative. Nevertheless, intradermal testing yielded positive results in all 3 patients. Management was by interruption of the culprit agent, which was followed by symptom resolution. The immunosuppressive treatment was continued with alternative drugs.. Appropriate nonirritating drug concentration solutions of the drug used for intradermal testing were highly sensitive and confirmed the clinical diagnosis of tacrolimus allergy in all the affected patients.. Immunosuppressive treatment with tacrolimus in the form of prolonged-release capsules may cause a drug hypersensitivity reaction. A suspicion of allergy warrants a referral for allergy testing. Pruritic rash refractory to treatment in liver transplanted patients should be evaluated by an allergist for possible drug allergy when bile stasis and graft disease have been excluded. Intradermal testing has proven a highly sensitive method for confirming a drug allergy diagnosis, whereas skin prick testing did not.

Topics: Aged; Delayed-Action Preparations; Drug Hypersensitivity; Exanthema; Humans; Immunosuppressive Agents; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Tacrolimus

Bullous scabies is an uncommon subtype of scabies that frequently mimics other blistering skin diseases. Nocturnal pruritus is a hallmark symptom of bullous scabies. We report an unusual case of bullous scabies presenting in the absence of pruritus in an immunosuppressed pediatric patient. It is critical that clinicians consider the diagnosis of bullous scabies in any patient with bullae, irrespective of pruritus symptoms.

Topics: Adolescent; Alagille Syndrome; Diagnosis, Differential; Exanthema; Follow-Up Studies; Humans; Immunocompromised Host; Ivermectin; Liver Transplantation; Male; Pemphigoid, Bullous; Pruritus; Risk Assessment; Scabies; Tacrolimus

A bath with scented soap prompted a flare of the boy's eczema. Days later, he was hospitalized with diffuse erosions covering 90% of his body. What was the cause?

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Child, Preschool; Eczema; Exanthema; Humans; Kaposi Varicelliform Eruption; Male; Mentha; Perfume; Simplexvirus; Soaps; Steroids; Tacrolimus; Tretoquinol

Case study A man, 77 years of age, presented with haematemesis, abdominal pain and increasing limb weakness. He also had a skin rash on his chest and face.

Topics: Administration, Topical; Aged; Dermatomyositis; Diagnosis, Differential; Exanthema; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Muscle Weakness; Tacrolimus

Mycophenolate mofetil (MMF) is a cornerstone immunosuppressive drug after liver transplantation (OLT). The aim of this study was to evaluate the long term results of the addition of MMF in maintenance OLT recipients.. From 1996 to 2006, MMF was introduced because of (1) histologic features of rejection or (2) calcineurin inhibitor (CNI) toxicity in order to reduce CNI dosage.. The study population included 208 patients (median, age 54 ± 9 years), with a median delay between OLT and MMF introduction of 54 ± 43 months. The median dosage of MMF was 1180 mg/d at the end of follow-up. After a median follow-up of 50 ± 26 months, 26.4% of the patients taking MMF did present ≥1 side effect and MMF discontinuation rate was 13.8% (transient in 3.8%). The main side effects were digestive disorders (45%), pruritus ± rash ± mucitis (12.7%), and myelosuppression (16.4%). MMF was withdrawn because of digestive disorders (17.2%), pruritus ± rash ± mucitis (17.2%), and myelosuppression (24.1%). The mean glomerular filtration rate as calculated by the Cockcroft-Gault formula value significantly increased after the introduction of MMF (58.1 vs 71.4 mL/min; paired t-test; P < .01). Improvement of renal function was significantly associated with initial association with tacrolimus (vs cyclosporine), initial trough level of cyclosporine (not tacrolimus), delay between OLT and MMF introduction, and age of renal impairment.. Our results suggest that the introduction of MMF in OLT maintenance recipients is efficient and well-tolerated (one quarter of the patients presented significant side effects, leading to treatment discontinuation in 10% of the patients).

Topics: Adult; Azathioprine; Cyclosporine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Drug Tolerance; Exanthema; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Function Tests; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Pruritus; Tacrolimus; Time Factors; Treatment Outcome

Topics: Administration, Cutaneous; Aged; Angiomatosis; Dermatologic Agents; Diagnosis, Differential; Emollients; Exanthema; Face; Female; Hand; Humans; Recurrence; Tacrolimus; Treatment Outcome

(1) In clinical trials of topical tacrolimus (an immunosuppressant), transient skin irritation, usually at the site of application, occurred in about 0.5% to 1.3% of adult patients who had also ingested ethyl alcohol. This adverse effect has also been observed with topical pimecrolimus, a related drug. (2) Three paediatric cases have also been published. The alcohol they ingested was one of the excipients of an oral drug. (3) If skin irritation occurs at the application site for topical tacrolimus, the role of ethyl alcohol, which may have been used as an excipient for a co-administered oral drug, should be borne in mind.

Topics: Adult; Child; Dermatitis, Atopic; Ethanol; Exanthema; Humans; Immunosuppressive Agents; Skin Diseases; Tacrolimus

Topics: Algorithms; Anti-Bacterial Agents; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Dermatologic Agents; Dermatology; Doxycycline; ErbB Receptors; Erlotinib Hydrochloride; Exanthema; Eye Diseases; Female; Humans; Interprofessional Relations; Lung Neoplasms; Medical Oncology; Middle Aged; Ophthalmology; Quinazolines; Referral and Consultation; Skin Diseases; Tacrolimus

We report an atopic dermatitis patient with recurrent hand dermatitis who developed a severe allergic contact dermatitis from the use of Elidel cream. Diagnostic patch tests showed an isolated contact allergy to the emulsifier oleyl alcohol present in the product. Pimecrolimus appeared to have had an aggravating effect on the dermatitis in spite of its immunosuppressive effects. The initial clinical appearance of the patient's widespread dermatitis was atypical with resemblance to subacute cutaneous lupus erythematosus. Even though emulsifiers are widely used in topical products, contact allergic reactions to these are relatively uncommon.

Topics: Adult; Allergens; Calcineurin Inhibitors; Dermatitis, Allergic Contact; Dermatologic Agents; Diagnosis, Differential; Exanthema; Fatty Alcohols; Female; Humans; Patch Tests; Tacrolimus

Topical treatment with tacrolimus may be complicated by ingestion-related flushing caused by consuming small amounts of alcohol, a reaction that can be mistaken for food allergy.. To increase awareness of a drug interaction with alcohol that can mimic food allergy.. We describe 3 patients who used topical tacrolimus, 2 with an atopic history and 1 without, who presented with a flushing reaction after ingesting alcohol.. Cessation of topical tacrolimus use resolves the alcohol-related skin reaction.. A careful history, including consideration of alcohol use, should be obtained in patients who use topical tacrolimus and present with new skin complaints, because these factors may be evidence of an avoidable drug interaction and not worsening of atopic disease or a food allergy.

Topics: Adult; Dermatitis, Atopic; Ethanol; Exanthema; Female; Food Hypersensitivity; Humans; Immunosuppressive Agents; Male; Tacrolimus

The rash of systemic lupus erythematosus (SLE) is usually treated with topical corticosteroids, but prolonged use causes adverse cutaneous side-effects. We assessed the efficacy of topical tacrolimus for treating the skin lesions of SLE. Three patients with SLE affecting their facial skin applied 0.1% tacrolimus ointment on one side of their face twice daily for 3 weeks, in conjunction with a sunscreen cream. After 3 weeks, erythema on the treated side was ameliorated in all three patients compared with the untreated side. Although the study is preliminary, the results demonstrate that topical tacrolimus may be useful for treating the malar rash of SLE.

Topics: Adult; Anti-Bacterial Agents; Exanthema; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Male; Ointments; Tacrolimus; Treatment Outcome

An 8-month-old child with an immunodeficiency disorder characterized by abnormal lymphocyte function and by low IgG and IgA levels had combined liver and small bowel transplantation under tacrolimus and steroid immunosuppression for the treatment of short gut syndrome and hepatic cirrhosis. The patient developed an early postoperative episode of Pneumocystis carinii pneumonia, and a subsequent surgical complication, prompting discontinuance of tacrolimus. A skin rash eventually shown to be graft-versus-host disease (GVHD) developed in the flank on the 12th post-transplant day and gradually became generalized. Peritonitis, sepsis, multisystem organ failure including the liver allograft led to death on the 23rd post-operative day. The mechanisms leading to post-transplant GVHD under the specific circumstances in this case are discussed.

Topics: Exanthema; Fatal Outcome; Female; Glucocorticoids; Graft vs Host Disease; Humans; IgA Deficiency; IgG Deficiency; Immunologic Deficiency Syndromes; Immunosuppressive Agents; Infant; Intestine, Small; Ischemia; Liver; Liver Cirrhosis; Liver Transplantation; Lymphocytes; Methylprednisolone; Multiple Organ Failure; Peritonitis; Pneumonia, Pneumocystis; Sepsis; Short Bowel Syndrome; Tacrolimus