tacrolimus and Facial-Dermatoses

Topics: Administration, Topical; Biopsy, Needle; Blood Chemical Analysis; Crohn Disease; Facial Dermatoses; Follow-Up Studies; Humans; Immunohistochemistry; Infliximab; Male; Photosensitivity Disorders; Psoriasis; Risk Assessment; Tacrolimus; Treatment Outcome; Tumor Necrosis Factor-alpha; Young Adult

Trichomegaly is a known adverse effect of systemic administration of cyclosporine but is less commonly associated with systemic tacrolimus or with topical calcineruin inhibitors. In this report, we describe the first case, to our knowledge, of trichomegaly due to long-term use of topical tacrolimus for periocular vitiligo.

Topics: Administration, Topical; Adolescent; Eyelashes; Facial Dermatoses; Humans; Male; Rare Diseases; Risk Assessment; Tacrolimus; Vitiligo

Granuloma faciale (GF) is a rare chronic dermatosis with still unknown etiopathology, which usually presents a solitary, asymptomatic, smooth reddish-brown to violaceous plaques or nodules on the face. Various therapeutic approaches, including topical application of corticosteroid or tacrolimus and removal with laser, cryotherapy and surgery have been attempted; however, the outcome has been inconsistent. Herein, we report a case of perinasal nodular GF who repeatedly underwent surgical excisions after the failure of laser treatment. Despite its nomenclature, GF does not manifest granulomatous tissue and the lesion is histopathologically characterized by dense dermal cell infiltration devoid of granulomatous changes and not distinguished by a clear border, which partially explains the difficulty of complete removal in our case. Review of the published work delineated that GF could be largely divided into two clinical subsets: plaque and nodular types. The plaque type GF could be responsive to topical tacrolimus, an approach preferentially adopted nowadays, while nodular type GF was often resistant to topical therapies and required surgical or laser removal. The latter subset often arose around the nose. For this location, surgical excision with sufficient removal margin is sometimes technically difficult when an aesthetically acceptable outcome is expected, explaining the basis for local recurrence. Postoperative recurrence could be observed after years of disease-free period. These observations indicated that the need for respective treatment strategies for the management of distinctive GF subsets. Of note, a multidisciplinary approach combining radical resection and additional supportive intervention with long-term follow up may be required for perinasal and nodular GF.

Topics: Biopsy; Combined Modality Therapy; Dermatologic Surgical Procedures; Facial Dermatoses; Granuloma; Humans; Lasers, Gas; Male; Middle Aged; Recurrence; Skin; Tacrolimus; Treatment Outcome

The treatment of vitiligo is still one of the most difficult dermatological challenges, although there are many therapeutic options. Narrow band ultraviolet B (NB-UVB) phototherapy is considered to be a very important modality for generalized vitiligo.. The aim of this study was to explore whether a combination of NB-UVB and topical agents would be superior to NB-UVB alone for treating vitiligo.. We searched the electronic databases such as PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary outcome was the proportion of ≥50% repigmentation (a clinical significance), and secondary outcome was the proportion of ≥75% repigmentation (an excellent response).. Seven randomized controlled trials (RCTs) involving 240 patients (413 lesions) were included in this meta-analysis. The study showed no significant difference between NB-UVB combination therapy (NB-UVB and topical calcineurin inhibitor or vitamin D analogs) and NB-UVB monotherapy in the outcomes of ≥50% repigmentation and ≥75% repigmentation. However, lesions located on the face and neck had better results in ≥50% repigmentation (RR = 1.40, 95% CI 1.08-1.81) and ≥75% repigmentation (RR = 1.88, 95% CI 1.10-3.20) with NB-UVB and topical calcineurin inhibitor combination therapy vs. NB-UVB monotherapy.. The meta-analysis suggested that adding neither topical calcineurin inhibitors nor topical vitamin-D3 analogs on NB-UVB can yield significantly superior outcomes than NB-UVB monotherapy for treatment of vitiligo. However, addition of topical calcineurin inhibitors to NB-UVB may increase treatment outcomes in vitiligo affecting face and neck.

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Calcitriol; Chemoradiotherapy; Dermatologic Agents; Dihydroxycholecalciferols; Facial Dermatoses; Humans; Neck; Randomized Controlled Trials as Topic; Skin Pigmentation; Tacrolimus; Ultraviolet Therapy; Vitamin D; Vitiligo

Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition.. Our objective was to critically review the published literature on topical treatments for facial SD.. We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies.. A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment.. Promiseb

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Antifungal Agents; Calcineurin Inhibitors; Ciclopirox; Dermatitis, Seborrheic; Dermatologic Agents; Desonide; Facial Dermatoses; Humans; Ketoconazole; Malassezia; Mometasone Furoate; Plant Preparations; Practice Guidelines as Topic; Pyridones; Quality of Life; Randomized Controlled Trials as Topic; Tacrolimus; Treatment Outcome; Vitamins

Systemic non-biologic agents have long been in clinical use in medicine--often with considerable efficacy, albeit with some adverse effects--as with all medications. With the advent of biologic agents, all of which currently are restricted to systemic use, there is a growing need to ensure which agents have the better therapeutic ratio. The non-biologic agents (NBAs) include a range of agents, most importantly the corticosteroids (steroids). Previous articles by us in this series have discussed systemic use of corticosteroids and purine synthesis inhibitors; the other immunomodulating agents (calcineurin inhibitors, thalidomide, dapsone, colchicine and cyclophosphamide) are reviewed in this final article.

Topics: Anti-Infective Agents; Calcineurin Inhibitors; Colchicine; Cyclophosphamide; Cyclosporine; Dapsone; Drug Interactions; Drug Monitoring; Facial Dermatoses; Humans; Immunosuppressive Agents; Mouth Diseases; Tacrolimus; Thalidomide; Tubulin Modulators

Granuloma faciale (GF) is a benign chronic condition characterized by recurrent plaques and nodules most commonly found on the face. We report a man with a 6-month history of plaques on his forehead and preauricular area consistent with GF that responded to twice-daily application of topical tacrolimus ointment, and who remains in remission 1 year later. This case supports previous reports of the successful use of topical tacrolimus in treating GF.

Topics: Administration, Topical; Dose-Response Relationship, Drug; Drug Administration Schedule; Facial Dermatoses; Follow-Up Studies; Granuloma; Humans; Immunosuppressive Agents; Male; Middle Aged; Severity of Illness Index; Tacrolimus; Treatment Outcome

Tacrolimus ointment and pimecrolimus cream are approved in the United States for treatment of atopic dermatitis. Tacrolimus and pimecrolimus are both calcineurin inhibitors and function as immunosuppressants. Their mechanisms have been discussed elsewhere. This article will discuss their utility in treating psoriasis.

Topics: Administration, Cutaneous; Animals; Calcineurin Inhibitors; Chemistry, Pharmaceutical; Double-Blind Method; Drug Evaluation, Preclinical; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Liposomes; Male; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Middle Aged; Occlusive Dressings; Ointments; Psoriasis; Randomized Controlled Trials as Topic; Skin Absorption; Tacrolimus; Treatment Outcome

Topics: Cellulitis; Dermatitis; Dermatomyositis; Facial Dermatoses; Humans; Immunosuppressive Agents; Impetigo; Lupus Erythematosus, Discoid; Ointments; Psoriasis; Rosacea; Tacrolimus

Topical corticosteroids (TCC) have significantly shaped dermatological therapy for five decades. A few months ago the TCC were joined by competition, the topical inhibitors of calcineurin (TIC), wrongly termed topical immunomodulators. The present paper reviews the pharmacological effects and clinical efficacy of TIC, compares the risks, benefits and costs of those two groups of topical drugs and develops a position on the use of TIC. While TIC have ushered in a new era of topical anti-inflammatory therapy, the age of TCC is far from over.

Topics: Acute Disease; Administration, Topical; Anti-Inflammatory Agents; Calcineurin Inhibitors; Cyclosporins; Dermatitis, Atopic; Eczema; Facial Dermatoses; Glucocorticoids; Humans; Immunosuppressive Agents; Neurodermatitis; Psoriasis; Pyoderma Gangrenosum; Risk Factors; Skin Diseases; Tacrolimus

No long-term maintenance therapy has been tested in patients with seborrheic dermatitis (SD).. We sought to compare the efficacy and tolerance of tacrolimus 0.1% ointment versus ciclopiroxolamine 1% cream as maintenance therapy for severe SD.. This double-blind randomized controlled study was conducted from 2014 to 2017 in 5 Dermatology Departments and 15 dermatology practices in France. Consecutive patients with severe and chronic facial SD were included. Patients were initially treated with desonide 0.05% cream twice daily for 7 days. Patients cleared after this open phase were randomized to receive tacrolimus 0.1% or ciclopiroxolamine 1% cream 2 times a week 24 weeks. The primary endpoint was disease-free-duration, defined as the time from randomization to first relapse.. One hundred fourteen patients were randomized (tacrolimus, n = 57; ciclopiroxolamine, n = 57). Twelve patients relapsed in the tacrolimus group after a median delay of 91.5 days (range 15-195 days) versus 23 patients in the ciclopiroxolamine group (median delay, 27 days [range 13-201 days]). Comparison of disease-free duration curves showed that patients in the tacrolimus group had a longer duration of complete remission than those in the ciclopiroxolamine group (P = .018), corresponding to a hazard ratio of relapse of 0.44 (95% confidence interval 0.22-0.89; P = .022).. The theoretical sample size was not reached.. Tacrolimus 0.1% is more effective than ciclopiroxolamine 1% as maintenance therapy for patients with facial SD.

Topics: Adult; Ciclopirox; Dermatitis, Seborrheic; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Humans; Maintenance Chemotherapy; Male; Middle Aged; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topical calcineurin inhibitors are used off label in the treatment of vitiligo, and there is a lack of placebo-controlled, blinded studies to support their use.. This study aimed to compare the efficacy of tacrolimus 0.1% ointment with that of the vehicle for repigmentation in adult patients with facial vitiligo.. This study was a 24-week multicenter randomized parallel double-blind study with a 24-week post-treatment follow-up extension.. Participants included were adult patients with recent facial vitiligo target lesions (<2 years) without changes in pigmentation or size over the previous 3 months.. Patients received either tacrolimus 0.1% ointment or vehicle twice daily.. The primary outcome was a therapeutic success, defined as a change ≥75% in the repigmentation of the target lesion between baseline and week 24, measured by ImageJ software. Secondary outcome measures were a variation of the physicians' global assessment scores and patients' satisfaction scores, safety data, and the rate of relapse at week 48.. A total of 42 patients were included. Therapeutic success was achieved in 65% of tacrolimus-treated patients versus 0% of vehicle-treated patients at week 24 (P < 0.0001). Only 40% of relapse was observed at 48 weeks.. Twice-daily tacrolimus 0.1% ointment showed superior efficacy to that of the vehicle through the 24 weeks of intervention and 24 weeks of follow-up in adult patients with facial vitiligo.. This study was registered at ClinicalTrials.gov (identifier: NCT02466997).

Topics: Administration, Cutaneous; Adult; Calcineurin Inhibitors; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ointments; Patient Satisfaction; Skin Pigmentation; Tacrolimus; Treatment Outcome; Vitiligo

The effectiveness of intermittent topical tacrolimus to prevent relapse in patients with stabilized facial seborrhoeic dermatitis has not been evaluated. The aim of this study was to determine whether proactive use of 0.1% tacrolimus ointment can keep adult facial seborrhoeic dermatitis in remission. A total of 75 patients who had stabilized facial seborrhoeic dermatitis after 2 weeks' (open-label induction) treatment with 0.1% tacrolimus were randomized in a double-blind fashion to treatment with 0.1% tacrolimus once a week, twice a week, or vehicle twice a week, for 10 weeks (maintenance). Significant improvement in erythema, scaling and pruritus compared with baseline was maintained during the maintenance phase in both tacrolimus groups, but not in the vehicle group. The mean recurrence rate according to global assessment was significantly higher in the tacrolimus once-weekly group than in the twice-weekly group. In conclusion, twice-weekly treatment with 0.1% tacrolimus ointment had superior effects in keeping facial seborrhoeic dermatitis in remission.

Topics: Administration, Cutaneous; Adult; Aged; Chi-Square Distribution; Dermatitis, Seborrheic; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Humans; Male; Middle Aged; Ointments; Remission Induction; Republic of Korea; Secondary Prevention; Tacrolimus; Time Factors; Treatment Outcome

Tacrolimus is a topical calcineurin inhibitor with immunomodulatory, anti-inflammatory, and fungicidal properties that may be beneficial in the treatment of facial seborrheic dermatitis.. We sought to compare the efficacy and safety of tacrolimus with standard corticosteroid treatment in adults with facial seborrheic dermatitis in a phase II, single-blind, randomized controlled trial.. Adult patients were enrolled in a 12-week study. Subjects were randomized to tacrolimus 0.1% ointment (n = 16) or hydrocortisone 1% ointment (n = 14) applied twice daily to symptomatic regions of the face. The primary efficacy measure was the severity of facial seborrhea at the end of treatment (day 84) as measured by the Seborrhea Area and Severity Index-Face. Secondary efficacy measures included physician and patient assessment of seborrhea, the frequency of medication application, and adverse events.. The severity of facial seborrhea was similarly improved in both treatment groups (P = .86). Tacrolimus 0.1% ointment was used on significantly fewer days than 1% hydrocortisone ointment (mean missed doses per patient at first visit: 15.6 vs 7.6, P < .05; at last visit: 13.5 vs 7.7, P = .08). The majority of doses were missed because of lack of symptoms. The adverse event profile for both agents was similar; however, there was a numerically higher incidence of adverse events in the hydrocortisone group.. This was a small, open-label study.. Tacrolimus 0.1% ointment required significantly fewer applications compared with hydrocortisone 1% ointment to achieve a comparable clinical response in adults with facial seborrheic dermatitis. Tacrolimus was generally well tolerated.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Dermatitis, Seborrheic; Facial Dermatoses; Female; Humans; Hydrocortisone; Immunosuppressive Agents; Male; Middle Aged; Ointments; Single-Blind Method; Tacrolimus; Young Adult

Atopic dermatitis (AD) is most prevalent in areas of reduced skin barrier reserve, like face and neck, especially in children. Treatment with topical corticosteroids (TCS) is limited due to heightened risk of treatment-associated side-effects, thus necessitating alternative AD therapies.. The primary study objective was to determine the efficacy of pimecrolimus cream 1% in children with mild-moderate facial AD dependent on/intolerant of TCS. Secondary objectives included effects on overall Eczema Area and Severity Index (EASI), head/neck EASI, pruritus severity and time to clearance of facial AD.. A multicentre, double-blind (DB) study of < or = 6 weeks, followed by a 6-week, open-label (OL) phase was conducted. Two hundred patients (aged 2-11 years) were randomized 1:1 to pimecrolimus cream 1% (n = 99) or vehicle (n = 101) twice daily until clearance of facial AD or for a maximum of 6 weeks (DB phase). Sixteen patients receiving vehicle were allowed to switch to the OL phase at day 22.. Significantly more pimecrolimus-treated vs. vehicle-treated patients were cleared/almost cleared of facial AD (Investigators' Global Assessment 0/1): 74.5% vs. 51.0%, P < 0.001 (day 43) [57.1% vs. 36.0%, P = 0.004 (day 22)]. Median time to clearance was 22.0 vs. 43.0 days (pimecrolimus vs. vehicle, respectively). Statistically significant differences for pimecrolimus vs. vehicle were also seen on head/neck EASI, overall EASI, and head/neck pruritus scores. Adverse events were mainly mild-moderate, occurring with similar frequency in both treatment groups.. In children with facial dermatitis intolerant of/dependent on TCS, pimecrolimus cream 1% effectively controls eczema and pruritus and is well tolerated.

Topics: Adrenal Cortex Hormones; Child; Child, Preschool; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Eczema; Facial Dermatoses; Female; Humans; Male; Pharmaceutical Vehicles; Pruritus; Severity of Illness Index; Tacrolimus; Treatment Outcome

No specific data are available on tacrolimus ointment as a second-line treatment in adults with facial eczema.. To compare tacrolimus 0.1% and fluticasone 0.005% ointments in adults with moderate to severe atopic dermatitis (AD) of the face in whom conventional treatment was ineffective or poorly tolerated.. Patients were randomized to double-blind treatment of facial AD with twice-daily tacrolimus ointment (n = 288) or fluticasone ointment (n = 280) for 3 weeks or until clearance. After day 21, patients could continue without the study treatment, apply the same ointment once daily, or switch to the other medication twice daily, depending on lesion clearance and patient/physician satisfaction. The primary endpoint was the day-21 response [> or = 60% reduction in the modified Local Eczema and Severity Index (mLEASI) score]. Secondary endpoints included facial erythema and pruritus, global clinical response, treatment switching at day 21 and safety. RESULTS Response with tacrolimus ointment (93%) was superior to that with fluticasone (88%; P = 0.026). Improvements in mLEASI components were also greater with tacrolimus ointment. Facial erythema and pruritus improved in both groups. Global clinical response was rated 'marked improvement' or better in 88% and 79% of patients in the tacrolimus ointment and fluticasone groups, respectively. At day 21, 9% of patients switched from fluticasone to tacrolimus ointment, while 4.5% switched from tacrolimus ointment to fluticasone. Adverse events were more frequent with tacrolimus ointment as a result of the higher incidence of application-site skin burning sensation. Safety of both drugs was in line with their respective summary of product characteristics.. Tacrolimus 0.1% ointment has superior efficacy to fluticasone 0.005% ointment for twice-daily treatment of adults with moderate to severe facial AD in whom conventional therapy was inadequately effective or not tolerated. Tacrolimus 0.1% ointment is a safe and effective second-line treatment for the control of moderate to severe AD of the face.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Androstadienes; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Fluticasone; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Tacrolimus; Treatment Outcome; Young Adult

Discoid lupus erythematosus (DLE) is commonly treated with topical agents, the most important of which are glucocorticosteroids. However, prolonged use of these agents, especially on sensitive areas such as the face, may result in side-effects (e.g. atrophy and telangiectases) by altering collagen synthesis. Therefore, alternative treatments are needed for these patients.. To investigate and compare the efficacy of topical pimecrolimus 1% cream and topical betamethasone 17-valerate 0.1% cream on facial lesions of DLE.. This was a randomized double-blind pilot study, performed in outpatient clinics of two major referral hospitals. Ten patients aged 20-53 years with moderate to severe DLE of the face were randomized into two groups for 8 weeks of treatment and 8 weeks of follow-up after treatment. In this double-blind study, one group applied pimecrolimus 1% cream twice daily and the other group applied betamethasone valerate 0.1% cream twice daily to facial lesions. Efficacy end-points included a combined score based on evaluation of erythema, infiltration and presence of scale.. Efficacy end-points showed significant improvement in both groups. A decrease of 86% and 73% in clinical severity scores was obtained for pimecrolimus and betamethasone, respectively (P = 0.043). There was no significant difference between the two groups in terms of efficacy (P = 0.1). No adverse effect was found at the end of the 8-week trial in any of our patients.. The efficacy of pimecrolimus 1% cream is comparable with that of betamethasone valerate 0.1% cream in treating facial DLE.

Topics: Administration, Cutaneous; Adult; Betamethasone Valerate; Double-Blind Method; Facial Dermatoses; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Male; Middle Aged; Pilot Projects; Severity of Illness Index; Tacrolimus; Treatment Outcome; Young Adult

Seborrheic dermatitis is commonly treated with anti-inflammatory products, including topical corticosteroids. Pimecrolimus cream 1% also exerts anti-inflammatory activity by inhibiting T-cell cytokine production.. We sought to compare the efficacy and safety of twice-daily pimecrolimus for treatment of moderate to severe facial seborrheic dermatitis.. This double-blind, vehicle-controlled, 4-week trial randomized patients with seborrheic dermatitis to pimecrolimus or vehicle (1:1). Clinical assessments (erythema [0-3] and scaling [0-3] combined for a total area score [0-6]) were performed at weeks 0, 2, and 4. Inclusion criteria included total area score 4 or greater and erythema 2 or greater. The prespecified primary variable, change from baseline in total area score at week 4, was analyzed using a two-sample t test for intent-to-treat and per protocol populations.. In all, 96 adults of mean age 59.6 years, 88.5% male, were randomized (n = 47 pimecrolimus; 49 vehicle). At week 4, the mean change from baseline in total area score was 3.7 versus 3.3 for pimecrolimus and vehicle groups, respectively (intent-to-treat: P = .1913; 95% confidence interval (CI) for difference [-0.195, 0.961]). Per protocol analysis (n = 41 pimecrolimus; 46 vehicle) indicated a significant difference between groups (mean change 3.9 pimecrolimus vs 3.2 vehicle; P = .0156; CI [0.129, 1.197]). The superiority of pimecrolimus was observed as early as week 2 (intent-to-treat: P = .0062; CI [0.132, 0.777]; per protocol: P = .0012; CI [0.410, 1.593]). No drug-related serious adverse events occurred. The most frequent drug-related adverse events were local, mild, and transient (pimecrolimus = 26%; vehicle = 12%).. Generalizability is limited by the elderly male study population.. This study suggests that pimecrolimus cream 1% is an effective and well-tolerated treatment for moderate to severe facial seborrheic dermatitis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Seborrheic; Double-Blind Method; Drug Administration Schedule; Drug Eruptions; Facial Dermatoses; Female; Humans; Male; Middle Aged; Patient Satisfaction; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topics: Adult; Clobetasol; Double-Blind Method; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Male; Ointments; Tacrolimus; Treatment Outcome

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

Two nonsteroidal topical agents, calcitriol and tacrolimus, have been reported to be effective and safe for psoriatic lesions on sensitive areas. However, no comparative studies between calcitriol and tacrolimus have been reported.. To compare the tolerability and efficacy of calcitriol 3 microg g(-1) and tacrolimus 0.3 mg g(-1) ointment in chronic plaque psoriasis affecting facial and genitofemoral regions.. This is a double-blind, parallel, 6-week study of 50 patients who were randomized in a 1 : 1 ratio to apply calcitriol or tacrolimus twice daily. The primary efficacy variable was the mean reduction of the target area score (TAS), and the secondary efficacy variable was the percentage of patients with the Physician's Global Assessment (PGA) score of 5 (clear) and 4 (almost clear) at the end of the study.. Both calcitriol and tacrolimus were well tolerated. Although calcitriol induced perilesional erythema in a statistically significant higher proportion of patients than tacrolimus (55% vs. 16% at week 6; P < 0.05), it did not necessitate treatment discontinuation. At the end of the study, tacrolimus was significantly more effective than calcitriol based on a significant reduction of mean TAS (67% vs. 51%; P < 0.05) as well as more patients achieving complete or almost complete clearance by PGA (60% vs. 33%; P < 0.05).. Both calcitriol 3 microg g(-1) and tacrolimus 0.3 mg g(-1) are safe and well-tolerated therapeutic agents in the treatment of psoriasis in sensitive areas. Tacrolimus demonstrated a more effective clinical outcome compared with calcitriol.

Topics: Administration, Cutaneous; Adult; Aged; Calcitriol; Dermatologic Agents; Double-Blind Method; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Psoriasis; Tacrolimus; Treatment Outcome; Vitamins

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

Topics: Administration, Cutaneous; Adult; Calcineurin Inhibitors; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; Humans; Hydrocortisone; Male; Peptidylprolyl Isomerase; Severity of Illness Index; Single-Blind Method; Tacrolimus; Treatment Outcome

Controlled studies established the efficacy and good tolerability of pimecrolimus cream 1% for the treatment of atopic dermatitis but they may not reflect real-life use.. To evaluate the efficacy, tolerability and cosmetic acceptance of a pimecrolimus-based regimen in daily practice in Switzerland.. This was a 6-month, open-label, multicentre study in 109 patients (55% > or = 18 years) with atopic dermatitis. Pimecrolimus cream 1% was incorporated into patients' standard treatment protocols.. The pimecrolimus-based treatment was well tolerated and produced disease improvement in 65.7% of patients. It was particularly effective on the face (improvement rate: 75.0%). Mean pimecrolimus consumption decreased from 6.4 g/day (months 1-3) to 4.0 g/day (months 3-6) as disease improved. Most patients (74.1%) rated their disease control as 'complete' or 'good' and 90% were highly satisfied with the cream formulation.. The use of a pimecrolimus-based regimen in everyday practice was effective, well tolerated and well accepted by patients.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Calcineurin Inhibitors; Child; Child, Preschool; Cohort Studies; Dermatitis, Atopic; Facial Dermatoses; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Ointments; Patient Satisfaction; Peptidylprolyl Isomerase; Safety; Tacrolimus; Treatment Outcome

To determine the safety and efficacy of pimecrolimus cream on lesions of discoid lupus erythematosus.. In an open-label phase II trial, patients with discoid lupus were treated with pimecrolimus 1% cream twice daily for 8 weeks. We assessed skin involvement with a clinical severity score, quality of life, patient improvement and toxicity. The changes were documented by skin biopsy at baseline and at the end of treatment.. Ten patients with a mean age of 34 +/- 17 yr and disease duration of 3 yr (range 1-8) were studied; 90% were female and 40% had received prior topical or systemic therapy without response. In all patients, improvement of skin damage was observed after therapy. A significant decrease of 52% was observed in the mean +/- s.d. clinical severity score, from 6.1 +/- 1.4 before treatment to 2.9 +/- 1.5 after treatment (P = 0.005). Quality of life score (0 = no effect, 100 = maximum effect on quality of life) showed a mean improvement of 46%, from 42.8 +/- 23.1 before to 23 +/- 16.5 after treatment (P = 0.008). According to the patients' assessment of the response to treatment, 50% qualified as marked improvement, 40% moderate and 10% slight improvement. The treatment was well tolerated; adverse reactions consisted of minimal erythema and pruritus, which resolved without any further action.. Our data suggest that pimecrolimus cream for discoid lupus erythematosus seems to be a safe and clinically effective option. However, this was an open and uncontrolled study, and double-blind, placebo-controlled studies are needed.

Topics: Adolescent; Adult; Child, Preschool; Dermatologic Agents; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Male; Middle Aged; Quality of Life; Severity of Illness Index; Tacrolimus; Treatment Outcome

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

Topical treatment of cutaneous lupus erythematosus usually includes potent glucocorticosteroids. However, prolonged use causes adverse side effects including skin atrophy as the foremost concern. In contrast to glucocorticosteroids, the anti-inflammatory and immunosuppressive macrolactam pimecrolimus has no atrophogenic potential. Affected areas of 11 patients with different forms of lupus erythematosus were treated with pimecrolimus 1% cream under semiocclusive conditions twice daily for 3 weeks. Skin involvement before and after therapy was assessed by means of a clinical score. In all patients, significant regression of skin lesions was observed after therapy (P <.001). This was an open and uncontrolled study on a limited number of cases. We suggest that pimecrolimus 1% cream could be an efficacious and safe treatment option for cutaneous lupus erythematosus.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Child; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Patient Acceptance of Health Care; Tacrolimus; Treatment Outcome

Intertriginous and facial involvement are manifestations of psoriasis that require a different approach than is used for typical plaque psoriasis on other skin areas. Topical corticosteroids are the primary treatment for psoriasis; however, the side effects of corticosteroids are magnified on intertriginous and facial skin. Topical tacrolimus offers the potential for anti-inflammatory effect without the atrophy or other local side effects associated with the use of topical corticosteroids.. To determine the efficacy and tolerability of 0.1% tacrolimus ointment for the treatment of facial or intertriginous psoriasis.. One hundred sixty-seven patients 16 years or older were evaluated in an 8-week, randomized, double-blind, vehicle-controlled, multi-center study. Upon entry into the study, patients were randomized 2:1 to apply the tacrolimus ointment 0.1% or vehicle twice daily to all psoriatic lesions of the face or intertriginous areas for 8 weeks. The physician's global assessment was used to assess improvement from baseline. The inverse psoriasis severity for patients was measured using a 6-point scale from clear to very severe.. As early as day 8, more patients ( P = .004) had cleared or achieved excellent improvement in the 0.1% tacrolimus ointment group compared to the vehicle group (24.8% vs 5.8%). At the end of the 8-week treatment period 65.2% of the tacrolimus ointment group and 31.5% of the vehicle were clear or almost clear ( P < .0001) based on a Static Severity Score. Adverse events were similar in the 0.1% tacrolimus ointment and vehicle groups. Conclusion Tacrolimus ointment is an effective treatment for psoriasis of the face or intertriginous areas.

Topics: Adolescent; Adult; Dermatologic Agents; Double-Blind Method; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Psoriasis; Tacrolimus

Chronic actinic dermatitis (CAD) is difficult to treat. Topical corticosteroids induce adverse effects after long-term use, especially on light-exposed skin.. Our purpose was to study the effects of tacrolimus ointment in the treatment of elderly patients with CAD.. In an open trial, 6 male patients between 51 and 80 years old with CAD applied 0.1% tacrolimus ointment twice a day to the face and neck. According to improvements, the frequency of application was reduced. Sunscreen agents were also applied outdoors.. Tacrolimus ointment effectively treated cutaneous changes in all patients. Symptoms were moderately improved in 2 weeks, and greatly in 4 weeks. A brief and localized irritating sensation occurred in all patients, but no other adverse events developed throughout the study course from 0.5 to 2.5 years.. Topical tacrolimus ointment for facial lesions of CAD appears to be effective and well tolerated and may provide long-term benefits.

Topics: Administration, Topical; Aged; Aged, 80 and over; Chronic Disease; Facial Dermatoses; Female; Follow-Up Studies; Humans; Japan; Male; Middle Aged; Ointments; Photosensitivity Disorders; Tacrolimus; Treatment Outcome

We identified 19 patients with facial atopic eczema who failed to respond to tacrolimus (FK506) ointment, although tacrolimus ointment has shown excellent benefit for the treatment of recalcitrant facial erythema in most patients with atopic dermatitis.. We attempted to determine the efficacy of an original lotion formulation of tacrolimus for facial atopic dermatitis resistant to tacrolimus ointment.. Recalcitrant facial erythema of these 19 patients was treated with an original tacrolimus lotion preparation for 6 months. Patch testing with white petrolatum was performed in both the 19 patients and in 30 other atopic dermatitis patients who had experienced excellent results with tacrolimus ointment.. Of the 19 resistant patients, those whose symptoms were greatly or moderately improved by the lotion were 95%, 89% and 89% after 2 weeks, 3 months and 6 months of treatment, respectively. Further, patch testing to petrolatum showed positive reactions in several (six of 19) patients, compared with none of 30 controls with atopic eczema that had responded to topical tacrolimus ointment.. The tacrolimus lotion had a significant effect on the recalcitrant facial erythema in adult patients with atopic dermatitis who were resistant to tacrolimus ointment. We suggest that one reason for the unresponsiveness to tacrolimus ointment may be because of contact sensitivity to white petrolatum.

Topics: Adolescent; Adult; Dermatitis, Atopic; Dermatitis, Contact; Dosage Forms; Drug Carriers; Drug Eruptions; Drug Resistance; Facial Dermatoses; Follow-Up Studies; Humans; Immunosuppressive Agents; Ointments; Patch Tests; Petrolatum; Tacrolimus

To investigate the safety and efficacy of using 0.1% tacrolimus ointment for long-term treatment of atopic dermatitis.. Open-label, noncomparative study with 6 to 12 months of follow-up.. Outpatient departments in 30 study centers in 11 European countries.. We enrolled 316 patients aged 18 years and older with moderate to severe atopic dermatitis, 200 for 6 months and 116 for 12 months; 77.5% of patients completed the study.. Twice-daily application of 0.1% tacrolimus ointment on all affected skin. Visits were scheduled on day 1; after 1, 2, and 4 weeks of treatment; and monthly thereafter.. Safety assessments included monitoring of adverse events, clinical laboratory values, and tacrolimus blood concentrations. Efficacy end points included a combined score (modified Eczema Area and Severity Index) and an investigator's global assessment.. Local irritation, adverse events such as burning sensation (47% of patients), pruritus (24% of patients), and erythema (12% of patients) were common but tended to occur only when initiating treatment. Laboratory values showed no marked changes over time. Systemic absorption was minimal, with the maximum tacrolimus blood concentration being less than 1 ng/mL in 76% of patients. All efficacy end points showed improvement. The mean (SD) modified Eczema Area and Severity Index score was 23.7 (12.6) at day 1, 13.5 (11.3) at week 1, 6.1 (9.2) at month 6, and 6.1 (8.1) at month 12. Marked or excellent improvement or clearance of disease was reported in 54%, 81%, and 86% of patients at week 1, month 6, and month 12, respectively.. Up to 1 year of tacrolimus ointment use was safe and effective in patients with atopic dermatitis. Arch Dermatol. 2000;136:999-1006

Topics: Administration, Topical; Adolescent; Adult; Aged; Dermatitis, Atopic; Europe; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Leg; Male; Middle Aged; Neck; Ointments; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Dermatologic Agents; Facial Dermatoses; Female; Humans; Hyperplasia; Ink; Lip; Middle Aged; Ointments; Tacrolimus; Tattooing

Topics: Administration, Topical; Adult; Facial Dermatoses; Granuloma; Humans; Immunosuppressive Agents; Male; Tacrolimus

Topics: Administration, Cutaneous; Adult; Asymptomatic Diseases; Dermatologic Agents; Facial Dermatoses; Female; Granuloma; Humans; Immunosuppressive Agents; Ointments; Pregnancy; Pregnancy Complications; Tacrolimus

Topics: Adult; Anti-Bacterial Agents; Dermatitis, Allergic Contact; Dermatologic Agents; Facial Dermatoses; Female; Humans; Lip Diseases; Mupirocin; Patch Tests; Tacrolimus

Topics: Administration, Cutaneous; Administration, Oral; Adult; Biopsy; Dermatitis, Contact; Dermatitis, Occupational; Drug Therapy, Combination; Facial Dermatoses; Glass; Humans; Male; Metronidazole; Minocycline; Ointments; Skin; Tacrolimus; Treatment Outcome

Topics: Administration, Oral; Administration, Topical; Biopsy, Needle; Combined Modality Therapy; Facial Dermatoses; Female; Humans; Hydroxychloroquine; Immunohistochemistry; Lichen Planus; Low-Level Light Therapy; Middle Aged; Prognosis; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Administration, Oral; Biopsy; Child; Drug Therapy, Combination; Erythromycin; Facial Dermatoses; Humans; Male; Ointments; Skin; Tacrolimus; Treatment Outcome

Topics: Adult; Aged; Anti-Inflammatory Agents; Facial Dermatoses; Female; Humans; Hydroa Vacciniforme; Lymphoma, T-Cell, Cutaneous; Minocycline; Skin Neoplasms; Sunscreening Agents; Tacrolimus

Topics: Child; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lentigo; Mouth; Tacrolimus; Vitiligo

We present a 13-year-old girl with Jessner lymphocytic infiltrate of the skin, who has suffered from the disease since the age of 9 years. It is a rare disease in childhood, and we highlight the clinical features and therapeutic response of tacrolimus.

Topics: Adolescent; Biopsy; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Lymphocytes; Lymphoproliferative Disorders; Rare Diseases; Skin; Tacrolimus

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

Topics: Administration, Cutaneous; Aged; Cheek; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lichen Sclerosus et Atrophicus; Tacrolimus; Telangiectasis

Topics: Acute Disease; Administration, Cutaneous; Amoxicillin-Potassium Clavulanate Combination; Autoimmune Diseases; Dermatologic Agents; Drug Hypersensitivity Syndrome; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Middle Aged; Ointments; Sinusitis; Tacrolimus; Vitiligo

We present a 40-year-old woman with a one-year history of a solitary and asymptomatic facial lesion. On physical examination a slightly infiltrated, smooth red to brown nodule was seen at the left malar region. A biopsy established the diagnosis of granuloma faciale. After two-months therapy with topical tacrolimus 0,1%, nodule was resolved.

Topics: Administration, Cutaneous; Adult; Facial Dermatoses; Female; Granuloma; Humans; Immunosuppressive Agents; Skin; Tacrolimus

Topics: Aged; Calcineurin Inhibitors; Facial Dermatoses; Female; Humans; Sarcoidosis; Tacrolimus

Topics: Anti-Inflammatory Agents; Eye; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Middle Aged; Panniculitis, Lupus Erythematosus; Prednisolone; Tacrolimus

Topical calcineurin inhibitors have been used outside their approved indications for a number of conditions, including topical steroid-induced rosacea. However, tacrolimus ointment itself has been reported to trigger rosacea in a small number of cases. We report a case of a rosacea-like eruption in a 39-year-old woman occurring after the use of pimecrolimus cream for 12 months for atopic dermatitis. Withdrawal of pimecrolimus combined with treatment with oral lymecycline, topical metronidazole, and an emollient resulted in resolution of the eruption. There have been 5 previously reported cases of a topical pimecrolimus-induced rosacea-like eruption suggesting that this rare side-effect may be a class effect of all topical calcineurin inhibitors. Dermatologists prescribing these drugs should be aware of this uncommon complication and may wish to warn patients of its occurrence as a potential side-effect when using topical calcineurin inhibitors in facial skin in adults.

Topics: Administration, Cutaneous; Adult; Dermatologic Agents; Drug Eruptions; Facial Dermatoses; Female; Humans; Peptidylprolyl Isomerase; Rosacea; Tacrolimus

Topics: Administration, Topical; Adult; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Mucinosis, Follicular; Ointments; Tacrolimus; Treatment Outcome

Topics: Administration, Oral; Administration, Topical; Adult; Anti-Infective Agents; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Metronidazole; Tacrolimus; Treatment Outcome

We report a case of an orofacial lesion in Crohn's disease successfully treated with tacrolimus ointment. A 22-year-old woman with Crohn's disease presented with a discharging lesion on the right side of her face. Intraorally, there was a resultant loss of the sulcal depth. She reported a 1-year history of variable right-sided facial swelling for which she had undergone extraoral incision and drainage, resulting in localized paresthesia and nonhealing of the incision site. Following exclusion tests, a treatment of twice-daily extraoral application of tacrolimus 0.1% ointment was commenced. Upon review, the lesion had reduced in size, with minimal discharge. Further improvement over 12 months of tacrolimus use resulted in a satisfactory cosmetic result as well as resolution of the intraoral features and reestablishment of the full sulcal depth. This case illustrates the successful use of topical tacrolimus to treat a cutaneous manifestation of Crohn's disease.

Topics: Administration, Topical; Crohn Disease; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Ointments; Tacrolimus; Young Adult

Topics: Administration, Topical; Dermatologic Agents; Facial Dermatoses; Female; Granuloma; Humans; Middle Aged; Tacrolimus

Topics: Adolescent; Diabetes Mellitus, Type 1; Diagnosis, Differential; Eye; Facial Dermatoses; Female; Giant Cells; Granuloma; Histiocytes; Humans; Immunosuppressive Agents; Necrobiosis Lipoidica; Necrobiotic Xanthogranuloma; Plasma Cells; Tacrolimus

We report an 18-year-old woman with lichen nitidus with exclusive facial distribution.

Topics: Adolescent; Anti-Inflammatory Agents; Facial Dermatoses; Female; Humans; Hydrocortisone; Immunosuppressive Agents; Lichen Nitidus; Photosensitivity Disorders; Tacrolimus

Lupus miliaris disseminatus faciei (LMDF) is a distinctive facial eruption of a debatable nosology, unknown etiology and spontaneously resolving course albeit with scarring. The aim of this study was to present the clinico-histopathological features, the rationale for treating and therapeutic response in patients with LMDF treated with different agents, and to attempt to clarify its nosology. Clinical details and demographic data of 29 biopsy-proven cases of LMDF were studied. Laboratory work up included complete blood count, erythrocyte sedimentation rate, tuberculin testing, chest X-ray, serum calcium levels and serum angiotensin-converting enzyme levels. Special stains like Ziehl-Neelsen, periodic acid Schiff and reticulin staining were used, and acid-fast bacilli culture was performed in each patient. The patients were treated with oral minocycline, dapsone, prednisolone and isotretinoin as monotherapeutic agents, or with a combination of oral dapsone plus prednisolone, and oral dapsone plus topical tacrolimus. Six patients had extrafacial lesions. Histological analysis revealed three different patterns: tuberculoid granuloma with central caseation necrosis in 20 patients; sarcoidal-like granuloma in six patients; and non-specific localized perifollicular lymphohistiocytic infiltrate in three patients. Nine out of 11 patients treated with minocycline did not respond, whereas dapsone and low dose prednisone alone or in combination produced good results. Topical tacrolimus with dapsone in seven patients yielded excellent results. Early and judicious use of medicines can clear this condition without scarring. LMDF should be accepted as a distinct entity. Facial idiopathic granulomas with regressive evolution (FIGURE), an acronym suggested is an apt, self-explanatory and easy term for LMDF, with no connotation of tubercular etiology.

Topics: Adult; Dapsone; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Lupus Erythematosus, Cutaneous; Male; Middle Aged; Prednisone; Tacrolimus; Treatment Outcome; Young Adult

Topics: Adrenal Cortex Hormones; Adult; Cyclosporine; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Occupational; Dietary Proteins; Drug Resistance; Facial Dermatoses; Female; Food Hypersensitivity; Hand Dermatoses; Histamine Antagonists; Humans; Immunosuppressive Agents; Methotrexate; Patch Tests; Skin Tests; Tacrolimus

Seborrheic dermatitis (SD) tends to reoccur frequently, so the therapeutic agent must have a high benefit versus adverse effect ratio for long-term and repetitive uses.. To assess the efficacy and safety of retreatment with pimecrolimus in SD patients.. A total of 45 patients who had been treated previously with pimecrolimus 1% cream were retreated with the same agent using the same treatment protocol after the disease reoccurred. The first and the second treatments were compared with regard to disease severity before treatment, complete cure times, remission times and side effects.. The median severities of the disease were 5 and 4 before the first and second treatments, respectively. Retreatment of the disease with pimecrolimus resulted in shorter cure and longer remission times. Side effects were seen only on the first day of the retreatment and an increase in erythema was seen in fewer patients.. Retreatment of the recurrence of SD with pimecrolimus as monotherapy is an effective and safe approach in the management of the disease.

Topics: Administration, Topical; Adult; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; Humans; Male; Ointments; Recurrence; Retreatment; Severity of Illness Index; Statistics, Nonparametric; Tacrolimus; Treatment Outcome

We describe herein 3 patients who developed rosacea-like dermatitis eruptions while using 0.03% or 0.1% tacrolimus ointment for facial dermatitis. Skin biopsy specimens showed telangiectasia and noncaseating epithelioid granulomatous tissue formation in the papillary to mid dermis. Continuous topical use of immunomodulators such as tacrolimus or pimecrolimus should be regarded as a potential cause of rosaceiform dermatitis, although many cases have not been reported.

Topics: Administration, Topical; Aged; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Rosacea; Skin; Tacrolimus; Telangiectasis

Linear lichen planopilaris of the face is a rare variant of lichen plano- pilaris. Asymptomatic follicular papules in a linear configuration are the characteristic clinical features. The incidence is still unknown, but there are a few cases reported exclusively in male adults. We present the case of a fourteen-year-old girl with linear lichen planopilaris of the face. Improvement was obtained with the use of tacrolimus 0.03 percent ointment.

Topics: Adolescent; Facial Dermatoses; Female; Humans; Lichen Planus; Ointments; Tacrolimus

Topics: Adult; Dermatologic Agents; Face; Facial Dermatoses; Female; Humans; Male; Middle Aged; Prednisone; Tacrolimus; Time Factors; Treatment Outcome; Vitiligo

Topics: Administration, Topical; Facial Dermatoses; Granuloma; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus

Topics: Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Mucinosis, Follicular; Tacrolimus; Young Adult

Topics: Aged; Facial Dermatoses; Female; Granuloma; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus

Topics: Administration, Cutaneous; Aged; Dermatologic Agents; Facial Dermatoses; Granuloma; Humans; Ointments; Tacrolimus; Treatment Outcome

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

Irritant dermatitis of the face and neck is particularly prevalent in women > or = 30 years old, who typically present with periocular cutaneous symptoms. Current therapies are limited, indicating a need for rapid, effective alternatives. Pimecrolimus cream 1%, a nonsteroid, cell-selective inhibitor of inflammatory-cytokine release, is effective in the treatment of inflammatory skin diseases, such as chronic irritant dermatitis of the hands, and thus offers a potential therapeutic option for this indication. This study reports on the safety and efficacy of pimecrolimus treatment in patients with irritant periocular dermatitis, extending to the face and neck in some patients.. Twenty-seven patients with periocular irritant dermatitis (extending onto the face and neck in eight) were treated twice daily with pimecrolimus cream 1% for 7 d, followed by once-daily application for a further 7 d. Erythema, swelling, and pruritus were assessed at baseline, weeks 1-4 using a 4-point clinical score (0, absent; 1, mild; 2, moderate; and 3, severe).. All patients showed marked improvement within 2-3 d of treatment with disease clearance in 23 of 27 patients within 14 d. In the remaining four patients, mild relapse occurred at weeks 3-4, but improvement was observed following a further 10-d treatment. Side-effects were mild and transient.. Pimecrolimus cream 1% provides a new potential option for treatment of irritant dermatitis of the periocular region, head and neck. Further double-blind, controlled studies are required to confirm the efficacy and safety of pimecrolimus cream 1% for this indication.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Biopsy, Needle; Dermatitis, Irritant; Dose-Response Relationship, Drug; Drug Administration Schedule; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunohistochemistry; Male; Middle Aged; Neck; Ointments; Patient Satisfaction; Prospective Studies; Tacrolimus; Treatment Outcome

Granuloma eosinophilicum faciale (GF) is a rare chronic inflammatory disorder of unknown etiology. Although the condition is benign, its treatment is often unsatisfactory. We describe a case of a 60-year-old man with GF resistant to therapy with topical corticosteroids and liquid nitrogen. After 4 months of treatment with topical tacrolimus the lesions resolved, with remission lasting for 2 years.

Topics: Administration, Topical; Facial Dermatoses; Granuloma; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus

Topics: Aged; Biopsy; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Sarcoidosis; Tacrolimus; Treatment Outcome

Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals.. A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD.. In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography.. Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period.. Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.

Topics: Administration, Topical; Adult; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; HIV Infections; Humans; Male; Middle Aged; Ointments; Pilot Projects; Recurrence; Tacrolimus; Treatment Outcome

Owing to severe itching and scratching, the natural course of lichen simplex chronicus (LSC) is clinically characterized by typical lichenoid lesions. Topical corticosteroids are often used to treat LSC but after withdrawal a relapse will sometimes occur. Therefore, LSC can be difficult to treat over time. We report a 13-year-old boy suffering from LSC on two symmetrical circumscribed areas on the temple, whose lesions healed completely with tacrolimus 0.1% ointment within approximately 9 months. During active treatment no adverse drug reaction was observed. The patient is completely free of symptoms 3 years after cessation of treatment. We conclude that topical tacrolimus can be used as an effective, long-lasting therapeutic modality in treating LSC, especially in sensitive skin areas such as the face.

Topics: Administration, Cutaneous; Adolescent; Diagnosis, Differential; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Neurodermatitis; Tacrolimus

To explore the effectiveness of pimecrolimus cream 1% used twice daily (BID) for the treatment of facial vitiligo.. Patients who had used pimecrolimus cream 1% monotherapy BID for at least 3 months and who had photographs taken at baseline and after initiation of therapy were analyzed in a retrospective study. The total affected surface area (cm2) of facial vitiligo in the baseline and follow-up photographs was compared. The extent of facial depigmentation was scored using a 7-point scale (0 = no disease to 6 = 100% involvement).. Eight patients met study entry criteria. Mean time from initiation of treatment to the final follow-up visit was 11 months (SD +/- 7.5 months). Mean affected surface area at baseline and follow-up were 79.40 cm2 and 17.96 cm2, respectively, (P = .012) with a mean percent improvement 72.5% (SD +/- 20.4%). Mean depigmentation score decreased from 2.8 at baseline to 1.4 at follow-up. No adverse events were reported.. Pimecrolimus cream 1% may be a viable alternative to current therapies for the treatment of facial vitiligo.

Topics: Adolescent; Adult; Dermatologic Agents; Facial Dermatoses; Female; Humans; Male; Middle Aged; Ointments; Retrospective Studies; Skin; Tacrolimus; Vitiligo

Topics: Acne Vulgaris; Adolescent; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Tacrolimus; Vitiligo

Topics: Adult; Animals; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Humans; Male; Mite Infestations; Mites; Rosacea; Skin; Tacrolimus

Topics: Administration, Topical; Adult; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Middle Aged; Sampling Studies; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Adult; Diagnosis, Differential; Eosinophilic Granuloma; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Skin; Tacrolimus

A 49-year-old male presented at our department with erythematous brownish plaques in the malar areas and left cheek of 9 years' evolution. Histopathological study revealed a dense, predominantly perivascular, inflammatory infiltrate in the reticular dermis. The infiltrate was composed of abundant neutrophils, lymphocytes, histiocytes, and eosinophils. Leukocytoclasia and fibrin in some vessel walls were also observed. The patient was diagnosed with granuloma faciale (GF). Direct immunofluorescence (DIF) study showed heavy immunoglobulin G (IgG) and less intense deposits of IgA, IgM, C(3) and C(1q) surrounding superficial and deep vessels of the reticular dermis. Perivascular and diffuse fibrinogen deposits were also present. No deposits were detected at the dermoepidermal junction. Our findings lend support to the hypothesis that classical pathway activation of complement may be involved in the development of vasculitis in GF.

Topics: Complement System Proteins; Face; Facial Dermatoses; Fluorescent Antibody Technique, Direct; Granuloma; Humans; Immunoglobulins; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Treatment Outcome

Granuloma faciale is a benign, chronic disease which is characterized by red-brown facial nodules and plaques. This quite rare disease is mostly seen in middle-aged males. A 41-year-old female patient consulted our department with a facial lesion of 4 years' duration. A dermatological examination revealed a pink-brown plaque of 1x5 cm over the nasal dorsum extending to the left malar region. Her personal and family histories were unremarkable. The routine hemogram and biochemical tests were normal, antinuclear antibody was negative. In the histopathological examination of the biopsy material which was taken from the lesion, the epidermis was intact; grenz zone was observed in the papillary dermis and with diffuse infiltrate with leukocytoclastic vasculitis and eosinophils, polymorphonuclear leukocytes and lymphocytes in the dermis were observed. With these findings, the patient was diagnosed with granuloma faciale and treatment with topical pimecrolimus cream 1% was started. The patient applied this treatment twice a day for 2 months and a dramatic recovery was observed after this period. The case is discussed in comparison with the literature.

Topics: Adult; Dermatologic Agents; Facial Dermatoses; Female; Granuloma; Humans; Tacrolimus

Discoid lupus erythematosus (DLE), a cutaneous form of lupus erythematosus, is characterized as atrophic and scaly erythema and the lesions are often refractory to a wide range of topical or systemic therapies. Herein, we present four cases of DLE that were successfully treated with topical tacrolimus. Tacrolimus ointment (0.1%) was applied to DLE lesions twice daily and the erythematous plaques readily diminished after 4-8 weeks. Adverse effects, such as burning sensation or irritations, were not observed. These results indicate that topical tacrolimus might be an effective and alternative treatment to control DLE.

Topics: Administration, Cutaneous; Adult; Aged; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Male; Middle Aged; Ointments; Tacrolimus; Treatment Outcome

Topics: Adrenal Cortex Hormones; Adult; Aged; Dermatologic Agents; Drug Eruptions; Facial Dermatoses; Female; Humans; Male; Rosacea; Tacrolimus

Recently, tacrolimus ointment has proved to be effective and well tolerated in patients with facial psoriasis. A few months ago we had the opportunity to treat a patient with tacrolimus ointment who had severe and recalcitrant plaque psoriasis of the face. This present case illustrates the impressive improvement of facial plaque psoriasis following 5 months of treatment with tacrolimus 0.1% ointment twice a day. Significant improvement of facial plaque psoriasis was seen after 1 month and complete clearance after 5 months of therapy. Based on the available literature and illustrated by the present case we may conclude that tacrolimus ointment 0.1% can be recommended as a first-line treatment for facial psoriasis.

Topics: Administration, Topical; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Psoriasis; Tacrolimus

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

Topics: Drug Eruptions; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Middle Aged; Mouth; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Dermatologic Agents; Facial Dermatoses; Humans; Immunosuppressive Agents; Psoriasis; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Adult; Dermatitis, Seborrheic; Dermatologic Agents; Drug Eruptions; Facial Dermatoses; Humans; Male; Ointments; Rosacea; Tacrolimus

Oral cicatricial pemphigoid is a chronic autoimmune blistering disease which affects predominantly the gingiva and the buccal mucosa. The pathogenesis of this disease is still incompletely understood; however, there is compelling evidence that cicatricial pemphigoid might be mediated by T lymphocytes. Therefore, we performed immunomodulatory therapy with topical tacrolimus in patients with long-standing, therapy-resistant oral cicatricial pemphigoid. Following 3 months of treatment, complete healing and ongoing remission could be achieved.

Topics: Aged; Autoimmune Diseases; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Mouth Diseases; Ointments; Pemphigoid, Bullous; Tacrolimus; Time Factors; Treatment Outcome

Since 1999, combination therapy with tacrolimus and topical steroids has been widely used for the treatment of adolescent/adult-type atopic dermatitis. In order to determine the clinical doses of topical tacrolimus and steroids for daily treatment of atopic dermatitis and to elucidate their beneficial and adverse effects, we analyzed the clinical data from 215 patients with atopic dermatitis who were more than 16 years old. Less than 70 g of tacrolimus and less than 15 g of steroids were applied to 90% of the patients on the face and neck, and less than 75.8 g of tacrolimus and less than 322 g of steroids were applied to 90% of the patients on the trunk and extremities during the six-month treatment period. Topical tacrolimus is much more frequently used on face and neck lesions (99.1%); in only 39.5% of cases was it used on the trunk and extremities. The majority of patients improved after six months of the combination topical therapy; however, atopic dermatitis was not controlled in 6% of the patients. The combination therapy did not seem to increase the risk of cutaneous infections; however, the incidence of herpes simplex infection on the face and neck was 2.8% at pre-treatment and slightly increased to 4.7% during the therapy. The incidence of all steroid-induced adverse effects was reduced both in frequency and intensity with a decrease in the dose of topical steroids through simultaneous tacrolimus application. Combination therapy with topical tacrolimus and steroids is useful for treating atopic dermatitis, but a small percentage of the patients still cannot be satisfactorily treated. For such patients, adjustments of the dose and rank of topical steroids and tacrolimus and other therapeutic adjuncts are necessary.

Topics: Administration, Cutaneous; Adult; Dermatitis, Atopic; Drug Administration Schedule; Drug Therapy, Combination; Extremities; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Severity of Illness Index; Steroids; Tacrolimus; Treatment Outcome

The action of tacrolimus ointment on pruritus in atopic dermatitis is still unclear. In this open study we investigated both the relationship between the severity of eruptions and the degree of itch and scratching in patients with atopic dermatitis and the effects of topical tacrolimus on these symptoms. Seventy adults with moderate to severe atopic dermatitis with facial eruptions that were recalcitrant to topical steroids applied a 0.1% tacrolimus ointment twice per day after discontinuation of topical steroid. The eruption scores and an assessment of the itch and scratching were recorded for 12 weeks. Oral antihistamine was prescribed at least one month before the study and continued unchanged during the study in each patient. The percentage reduction in the score of itch and scratching after two weeks (n=59) was significantly higher than in the score of eruption. Although there was no significant relationship between the severity of the eruptions and the degree of itch and scratching during steroid application, a relationship became significant after four weeks (n=59) of tacrolimus use by a one-factor ANOVA analysis. This suggests that tacrolimus ointment is effective for the itch and scratching in cases where degrees might be discrepant from the severity of eruptions in patients with recalcitrant facial eruptions of AD.

Topics: Administration, Topical; Analysis of Variance; Dermatitis, Atopic; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Ointments; Probability; Prospective Studies; Pruritus; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topics: Facial Dermatoses; Granuloma; Humans; Immunosuppressive Agents; Male; Middle Aged; Remission Induction; Tacrolimus

Therapeutically, chronic actinic dermatitis is a problematic condition. Frequently applied sunscreen usually fails to mitigate the clinical symptoms, and steroids--while efficient--exert many undesired side-effects with prolonged usage. We present a case of chronic actinic dermatitis responding well to topically applied tacrolimus (Protopic) in combination with chemical and physical UV protection.

Topics: Administration, Topical; Agriculture; Chronic Disease; Dermatitis, Photoallergic; Dose-Response Relationship, Drug; Drug Administration Schedule; Facial Dermatoses; Follow-Up Studies; Humans; Male; Middle Aged; Severity of Illness Index; Tacrolimus; Treatment Outcome; Ultraviolet Rays

Topics: Administration, Topical; Adrenal Cortex Hormones; Biopsy, Needle; Dermatitis, Atopic; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunohistochemistry; Immunosuppressive Agents; Middle Aged; Ointments; Risk Assessment; Rosacea; Severity of Illness Index; Tacrolimus; Treatment Outcome

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

We report a 22-year-old Japanese woman with facial lichen striatus (LS). The distribution of the lesions corresponded to that of Blaschko's lines. Histology of the lesional skin showed an inflammatory cell infiltrate around hair follicles and eccrine glands. Treatment of the linear lesions with tacrolimus ointment once or twice daily resulted in a dramatical improvement in a short time. LS is a T-cell-mediated inflammatory disease and tacrolimus ointment may be an effective alternative treatment for this disease especially when the lesions are located on the face.

Topics: Adult; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lichenoid Eruptions; Microscopy, Electron; Ointments; Tacrolimus

Topics: Administration, Cutaneous; Adult; Chronic Disease; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Severity of Illness Index; Tacrolimus; Ultraviolet Rays; Vitiligo

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Calcineurin Inhibitors; Dermatitis, Atopic; Doxycycline; Facial Dermatoses; Female; Humans; Mite Infestations; Rosacea; Tacrolimus

Topics: Administration, Cutaneous; Dermatomycoses; Diagnosis, Differential; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Psoriasis; Tacrolimus

Topics: Administration, Cutaneous; Adult; Dermatitis, Atopic; Diagnosis, Differential; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Ointments; Skin Neoplasms; Tacrolimus

Topics: Adult; Aged; Child; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Psoriasis; Tacrolimus

Granuloma faciale (GF) is a rare, chronic skin disorder in which numerous treatment modalities have been used without any consistent long-term effect. We report three cases of GF, two of which were successfully treated with the Laserscope potassium-titanyl-phosphate 532-nm laser within 2 weeks and one with topical tacrolimus ointment 0.1%. Our observations suggest that these new treatment modalities for GF, which we report here for the first time, can provide effective and non-invasive treatment for this disease.

Topics: Aged; Combined Modality Therapy; Facial Dermatoses; Female; Granuloma; Humans; Immunosuppressive Agents; Laser Therapy; Male; Middle Aged; Phosphates; Tacrolimus; Titanium

Topics: Facial Dermatoses; Humans; Immunosuppressive Agents; Ointments; Photosensitivity Disorders; Tacrolimus; Treatment Outcome

Topics: Facial Dermatoses; Follow-Up Studies; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Male; Middle Aged; Ointments; Skin; Tacrolimus; Time Factors

Topics: Administration, Cutaneous; Adult; Facial Dermatoses; Female; Follow-Up Studies; Humans; Ointments; Pigmentation; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vitiligo

Topics: Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Plasmacytoma; Skin Neoplasms; Tacrolimus

Chronic actinic dermatitis (CAD) is a photosensitivity disorder marked by severe eczematous lesions on exposed areas. Although associations with contact dermatitis, atopic dermatitis, and human immunodeficiency virus (HIV) have been suggested, its pathogenesis remains unknown. CAD is often refractory, and systemic administration of cyclosporin A has been the treatment of choice. Recently, topical tacrolimus therapy has been reported to be effective. We report the efficacy of topical tacrolimus treatment in a CAD patient who also had the complication of idiopathic leukopenia. A phototest showed marked suppression of erythema formation in the skin pre-treated with tacrolimus before UVB radiation but not in the skin treated after the irradiation. Therefore, it is suggested that tacrolimus may prevent UV-B induced erythema by suppressing a very early phase of the inflammatory process in CAD.

Topics: Administration, Cutaneous; Aged; Diagnosis, Differential; Facial Dermatoses; Humans; Immunosuppressive Agents; Leukopenia; Male; Photosensitivity Disorders; Skin Tests; Tacrolimus

Topics: Administration, Topical; Chronic Disease; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Middle Aged; Scalp Dermatoses; Tacrolimus

Topics: Aged; Aged, 80 and over; Facial Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Photosensitivity Disorders; Tacrolimus

Topics: Administration, Topical; Adult; Chronic Disease; Dermatitis, Photoallergic; Facial Dermatoses; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Tacrolimus; Treatment Outcome

Sarcoidosis is a disorder characterized by macrophage- and T-cell-mediated responses to as yet unidentified infectious antigens or autoantigens. We describe a 62-year-old woman with a 10-year history of orange-yellow plaques of sarcoidosis on her face. Her cutaneous lesions responded to topical tacrolimus ointment after unsuccessful treatment with topical and systemic corticosteroids. No adverse effects were noted with topical tacrolimus in this patient. We discuss the mode of action by which this immunosuppressive agent may act against sarcoidosis.

Topics: Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Middle Aged; Sarcoidosis; Tacrolimus

Topical corticosteroids are commonly applied in atopic dermatitis (AD) treatment. However, their chronic use may be associated with significant side effects at the application site. Skin atrophy and other undesirable effects are frequently seen after long-term corticosteroid treatment. In addition, when application of corticosteroids is discontinued, a rebound phenomenon in the facial lesions can occur within several days. Topical tacrolimus, an immunosuppressant currently used to prevent rejection after solid-organ transplantation, presents a potential alternative therapeutic agent for AD.. The present study is the first trial designed to evaluate the efficacy and safety of topically applied tacrolimus ointment after corticosteroid discontinuation without a washout phase in severe, long-term facial AD.. Forty-seven patients with facial refractory AD were recruited, of whom 38 had undergone topical corticosteroid treatment for at least 4 weeks before enrollment (group 1) and the other 9 had not received steroid treatment (group 2). All 47 patients received 0.1% tacrolimus ointment, and the severity index and pruritus score were assessed as an AD clinical activity index every week and compared with baseline data.. Both the severity index and pruritus score improved significantly in group 1 after 1 and 2 weeks of application (p < 0.01, respectively). Group 2 showed the greatest improvement at 4 weeks (p < 0.05). In this trial, none of the patients experienced a rebound phenomenon associated with tacrolimus treatment. A transient sensation of burning at the application site was the only adverse event in 31 of the 47 (66%) enrolled patients, but this condition improved after several days. Spectrophotometric assessment of the facial lesion following treatment revealed significant improvement in group 1 (p < 0.05).. The present results indicate that topical tacrolimus treatment following corticosteroid discontinuation is safe and effective in refractory facial AD.

Topics: Administration, Topical; Adolescent; Adult; Dermatitis, Atopic; Dermatologic Agents; Facial Dermatoses; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; 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

Recent evidence suggests that 0.1% tacrolimus ointment is an effective treatment of atopic dermatitis. Tacrolimus is an immunosuppressive agent that interferes with cell-mediated immunity. We have observed 2 cases of eczema herpeticum among 36 patients with atopic dermatitis treated with a topical preparation containing 0.1% tacrolimus. A 29-year-old male patient developed generalized herpetic lesions on his face on the 4th day of treatment. His SCORAD was then 73, and the tacrolimus blood level was 7.5 ng/ml. A 23-year-old woman developed disseminated herpetic lesions on her neck, face, shoulders and legs during the 9th week of treatment. Her SCORAD was then 41, tacrolimus blood levels were <3 ng/ml 2 weeks before the infection. Herpes simplex virus type 1 antigens were identified in several lesions by direct immunofluorescence in both patients. Neither patient recalled previous episodes of cold sores. The lesions resolved quickly under intravenous acyclovir treatment but resulted in important facial scarring in the male patient.. Eczema herpeticum is a well-known complication of atopic dermatitis. Available data do not allow to link topical tacrolimus with an increased risk for eczema herpeticum, but they are insufficient to exclude an association. Future studies and careful documentation of cases are needed in order to better characterize patients at risk.

Topics: Adult; Dermatitis, Atopic; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Kaposi Varicelliform Eruption; Male; Ointments; Tacrolimus

Topics: Administration, Topical; Adolescent; Adult; Dermatitis, Atopic; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Male; Tacrolimus