tacrolimus and Granuloma

Childhood granulomatous periorificial dermatitis (CGPD), considered a clinical variant of perioral dermatitis, typically affects prepubertal children of African descent. It is a condition of unknown etiology characterized by the presence of a monomorphic yellow-brown papular eruption limited to the perioral, perinasal, and periocular regions that histopathologically shows a granulomatous pattern. This disorder should be differentiated from other conditions as granulomatous rosacea, sarcoidosis, and lupus miliaris disseminatus faciei. We report a case of a 9-year-old boy who presented with flesh-colored perorificial papules on the face, evolving for two months. Upon treatment with topical tacrolimus for follicular eczema, an aggravation of the condition was observed. A skin biopsy confirmed the diagnosis of CGPD. Our patient was successfully treated with a combination of topical metronidazole and topical erythromycin.

Topics: Administration, Topical; Anti-Infective Agents; Biopsy; Child; Dermatitis, Perioral; Drug Therapy, Combination; Erythromycin; Face; Granuloma; Humans; Immunosuppressive Agents; Male; Metronidazole; Skin; Tacrolimus

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

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

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

Granuloma gluteale infantum is a rare nodular complication of irritant diaper dermatitis. The association of this condition with the widespread use of nondisposable cloth diapers has been increasingly recognized. We present the case of an 18-month-old girl with granuloma gluteale infantum. Our aims are to emphasize the importance of clinical recognition of this re-emerging complication of diaper dermatitis and to point out the potential role of topical calcineurin inhibitors as a treatment option.

Topics: Administration, Cutaneous; Buttocks; Calcineurin Inhibitors; Dermatologic Agents; Diaper Rash; Diapers, Infant; Female; Granuloma; Humans; Infant; Ointments; Skin Diseases; Tacrolimus

Pulmonary alveolar echinococcosis is a rare but potentially severe condition.. We report the case of a 50-year-old woman suffering from pulmonary alveolar echinococcosis who had had a renal transplant for polycystic liver and kidney disease. A lung opacity was identified radiologically in May 2013. Both broncho-alveolar lavage and bronchial biopsy were uninformative. In January 2014, a follow up CT-scan showed the opacity to be enlarging. A surgical biopsy revealed a giant cell epithelioid granuloma with caseous necrosis suggesting a diagnosis of pulmonary tuberculosis. Antituberculous treatment was started but cultures remained negative. A histological revue was therefore requested in March 2014. This suggested bronchocentric granulmatosis, possibly associated with echinococcosis. This hypothesis was finally confirmed serologically. Treatment for alveolar echinococcosis was begun in June 2014 after consultation with the national reference centre for parasitology.. Outside endemic areas and in the absence of hepatic involvement pulmonary alveolar echinococcosis can be difficult to diagnose. This case report focuses on the diagnostic criteria and treatment.

Topics: Echinococcosis; Echinococcosis, Hepatic; Echinococcosis, Pulmonary; Female; Granuloma; Humans; Immunocompromised Host; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Radiography, Thoracic; Renal Insufficiency; Tacrolimus

Allergic conjunctival granuloma is a rare cause of conjunctival ocular lesions. The aim of this case report was to present a successful treatment of an allergic conjunctival granuloma with topical tacrolimus eye drops. A 20-year-old female presented with bilateral multiple yellow nodules of the bulbar conjunctival epithelium and conjunctival injection. The patient had tearing, photophobia, itching, foreign body sensation, and red eye. The patient's signs and symptoms progressed despite the use of topical steroids. The patient was treated by application of tacrolimus eye drop (0.005%) in her right eye every 6 h while the left eye was put on placebo. Her signs and symptoms were recorded at each visit. After 3 weeks' therapy with topical tacrolimus eye drop, the patient became asymptomatic in her right eye and conjunctival granulomas fully resolved. Topical tacrolimus seems to be an effective therapeutic option for the treatment of allergic conjunctival granulomas.

Topics: Administration, Ophthalmic; Conjunctivitis, Allergic; Female; Granuloma; Humans; Immunosuppressive Agents; Ophthalmic Solutions; Tacrolimus; Young Adult

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: Administration, Cutaneous; Crohn Disease; Granuloma; Humans; Immunosuppressive Agents; Male; Penile Diseases; Recurrence; Skin Diseases; Tacrolimus; Young Adult

Topics: Aged, 80 and over; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Drug Therapy, Combination; Face; Granuloma; Humans; Immunosuppressive Agents; Infliximab; Male; Neck; Pyoderma; Tacrolimus; Torso

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

Topics: Adrenal Cortex Hormones; Adult; Aged; Anti-Bacterial Agents; Breast Diseases; Colchicine; Diabetes Mellitus, Type 2; Drug Resistance; Female; Granuloma; Humans; Hypertension; Immunosuppressive Agents; Isotretinoin; Male; Pyoderma Gangrenosum; Remission Induction; Tacrolimus

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

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

A case of childhood granulomatous perioral dermatitis (CGPD)/facial Afro-Caribbean childhood eruption (FACE) in a three year old boy from Madagascar is described. This disorder occurs predominantly in black children until puberty. It is a relatively uncommon condition of unknown aetiology characterized by a monomorphic, papular eruption around the mouth, nose and eyes. The disorder looks like sarcoidosis, but it is benign and self-limited and not associated with any systemic manifestations. In our case we treated the patient with Elidel (pimecrolimus) with an excellent result.

Topics: Child, Preschool; Dermatitis; Dermatologic Agents; Granuloma; Humans; Male; Mouth; Tacrolimus

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: Administration, Topical; Child; Dermatitis; Face; Granuloma; Humans; Immunosuppressive Agents; Male; Tacrolimus

Topics: Antibodies, Monoclonal; Child, Preschool; Cyclosporine; Diagnostic Errors; Dwarfism; Granuloma; Hematuria; Humans; Immunosuppressive Agents; Infliximab; Male; Nephritis, Interstitial; Nephrosis, Lipoid; Nephrotic Syndrome; Obesity; Prednisolone; Proteinuria; Puberty, Delayed; Recurrence; Remission Induction; Tacrolimus; Tumor Necrosis Factor-alpha

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

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

Assessment of the immune system's capability to respond to antigens with the generation of specific antibodies, whilst under the influence of a test article, is required in toxicity tests according to the European guideline for repeated dose toxicity testing of medicinal products. The purpose of this study in rats was to validate methodology for the determination of Keyhole Limpet Haemocyanin (KLH)-specific antibodies under the influence of an immunologically active compound. The immunosuppressant FK506, commercially available as Prograf, was administered orally (gavage) to five rats per sex per group at dosages of 0.5mg/kg per day or 3mg/kg per day, for a period of 4 weeks. On days 14 and 22, KLH was administered subcutaneously, with an adjuvant (AluGel), to the two treated groups and a control (i.e. without FK506 treatment) approximately 1h following administration of FK506. Terminal investigations included haematology parameters, titration of KLH-specific antibodies in serum (ELISA), macroscopic pathology, spleen and thymus weights, immunophenotyping of splenocytes (FACS analysis) and histopathology of the lymphatic tissues. At 3mg/kg per day a minimal reduction of subcutaneous KLH-induced granuloma formation and a moderate to marked reduction of germinal centre development (axillary lymph node and spleen) were observed. Reduced CD4+ (T-cell) counts were found in the spleen of males, consistent with a suppressed production of KLH-specific antibodies (IgG in both sexes, IgM in males only) and a higher incidence of atrophy in the periarteriolar lymphoid sheaths of males. Slight-to-moderate lymphopenia was present in both sexes at 3mg/kg per day. These findings are consistent with the known pharmacological activity of FK506. In conclusion, determination of antibody titres following immunisation of rats with KLH, with concurrent exposure to a drug, appears to be a valid method in the context of the immunotoxicity evaluation required by European regulation.

Topics: Animals; B-Lymphocytes; CD4 Lymphocyte Count; CD8-Positive T-Lymphocytes; Enzyme-Linked Immunosorbent Assay; Female; Granuloma; Hemocyanins; Immunity; Immunity, Cellular; Immunoglobulin G; Immunosuppressive Agents; Lymph Nodes; Lymphocyte Count; Male; Organ Size; Phenotype; Rats; Rats, Wistar; Reproducibility of Results; Sex Characteristics; Spleen; T-Lymphocytes; Tacrolimus

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

A case of intraocular posttransplant lymphoproliferative disorder (PTLD) is described in a 9-year-old female who underwent orthotopic liver transplantation at the age of 18 months. The prevalence of ophthalmic involvement in PTLD can be expected to rise with the increasing number of major organ transplantations, as well as improved survivorship. Children are particularly at risk for this posttransplant complication because they are usually seronegative for the Epstein-Barr virus (EBV) prior to transplant. Accurate diagnostic classification of PTLD to include confirmation of EBV infection carries significant therapeutic and prognostic implications.

Topics: Child; Diagnosis, Differential; DNA, Viral; Epstein-Barr Virus Infections; Eye Infections, Viral; Female; Graft Rejection; Granuloma; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Iris Diseases; Liver Transplantation; Lymphoproliferative Disorders; Tacrolimus; Uveitis

Topics: Dermatomycoses; Granuloma; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Tacrolimus

The effects of the immunosuppressive agents FK506 (tacrolimus) and cyclosporin (CyA) on Candida albicans infection in mice were compared with those of cyclophosphamide. FK506 and CyA did not exacerbate C. albicans infection in mice when the effects were determined on the basis of survival ratio and colony forming units (CFU) in the kidney, although cyclophosphamide (CY) impaired the host defence mechanisms of mice against C. albicans infection. The effects of FK506 and CyA on the body weight of mice, histopathological changes of lymphoid tissues and formation of granulomas in kidney were also studied in comparison with those of CY.

Topics: Animals; Brain; Candidiasis; Cyclophosphamide; Cyclosporine; Granuloma; Immunosuppressive Agents; Kidney Cortex; Lymphoid Tissue; Male; Mice; Mice, Inbred BALB C; Stem Cells; Survival Analysis; Tacrolimus