tacrolimus and Granulomatous-Disease--Chronic

The disseminated cutaneous granulomatosis (DCG) are heterogeneous cutaneous diseases histologically characterized by a granulomatous infiltrate. The most frequent cutaneous granulomatosis is sarcoidosis, but many other causes can be found, because DCG are probably a skin granulomatous reaction to different stimuli: infectious, inflammatory, neoplastic, metabolic or chemical. The histopathological examination is useful for the diagnosis of DCG, but gives rarely an etiological diagnosis. In this article, we will propose a strategy for the etiological diagnosis of DCG, and propose therapeutic recommendations based on recent data from the literature.

Topics: Administration, Cutaneous; Biopsy; Dermatologic Agents; Drug Therapy, Combination; Granuloma Annulare; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Phototherapy; Practice Guidelines as Topic; Retinoids; Sarcoidosis; Skin Diseases; Tacrolimus; Treatment Outcome; Tumor Necrosis Factor-alpha

Childhood granulomatous periorificial dermatitis (CGPD) is a granulomatous disease characterized by monomorphous, small papular eruptions around the mouse, nose and eyes, and is thought to be closely related to perioral dermatitis. This condition has always been believed to occur more commonly in dark-skinned patients; however, recent observations have revealed CGPD to occur also in white patients.. We report an 11-year-old Japanese boy with the characteristic features of CGPD. Although sarcoidosis and acne/granulomatous rosacea could be differentiated from CGPD, we could find no essential differences between CGPD and lupus miliaris disseminatus faciei (LMDF). The cases of LMDF in children, which were recorded in the Japanese literature, had highly similar clinicopathological features to those of CGPD. This case responded dramatically to topical tacrolimus in combination with the oral administration of minocycline.. The entity 'facial idiopathic granulomas with regressive evolution' is considered to include LMDF (a common adult form), CGPD (a rare childhood form) and perioral dermatitis (a peculiar form exacerbated by topical corticosteroids). Topical tacrolimus may be recommended as one of the therapies for LMDF as well as CGPD.

Topics: Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Child; Dermatitis, Perioral; Diagnosis, Differential; Drug Therapy, Combination; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Lupus Vulgaris; Male; Minocycline; Tacrolimus

Topics: Acute Disease; Bone Marrow Transplantation; Child; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Male; Pancreatitis; Tacrolimus; Transplantation, Homologous

The objective of this study was to quantitatively characterize the effects FK506 on the pathophysiology observed in a model of chronic granulomatous colitis in rats and compare these effects to those obtained with cyclosporin A (CyA). Chronic granulomatous colitis was induced in female Lewis rats via intramural (subserosal) injections of peptidoglycan/polysaccharide (PG/PS) into the distal colon. Rats then received daily injections (i.m.) of either vehicle for CyA (0.5 ml/kg cremophor), CyA in vehicle (25 mg/kg), saline (0.5 ml/kg) or FK506 (1 mg/kg in saline), beginning 7 days after PG/PS injection and continuing for an additional 2 weeks. On day 21, we found that the intramural injection of PG/PS produced a chronic colitis that was associated with hepatic and splenic granulomatous inflammation. Daily treatment with CyA or FK506 beginning 7 days after the induction of colitis resulted in significant inhibition in colonic mucosal permeability, colonic myeloperoxidase activity and plasma nitrate/nitrite levels when compared with their vehicle or untreated controls. In some instances, we noticed a significant vehicle-dependent anti-inflammatory activity. The incidence of peritoneal adhesions as well as the presence of hepatic and splenic granulomas induced by PG/PS were also significantly reduced in both the CyA- and FK506-treated groups. Taken together, these data suggest that immunosuppressive therapy is effective at attenuating both the colitis as well as the extraintestinal inflammation induced by PG/PS. We conclude that FK506 may be useful in the treatment of certain types of inflammatory bowel disease.

Topics: Animals; Blood Pressure; Body Weight; Colitis; Colon; Cyclosporine; Female; Granulomatous Disease, Chronic; Intestinal Mucosa; Liver; Nitrates; Nitrites; Organ Size; Peptidoglycan; Polysaccharides; Rats; Rats, Inbred Lew; Spleen; Tacrolimus