tacrolimus and Hand-Dermatoses

Nail involvement in lichen striatus (LS) is rare and has not been documented extensively.. This study describes the clinical and histological features, response to treatment, and follow-up in seven patients with nail LS.. We reviewed seven cases of nail LS between 2006 and 2012 at the Dermatology Department, Yeouido St Mary's Hospital, Seoul, South Korea.. The median patient age was 11 years (range: 4-33 years), and the female:male ratio was 3:4. All patients had both typical skin lesions and nail abnormalities. In these cases, LS usually involved a single digit (n = 5). The most common nail change was longitudinal fissuring (n = 4). We actively treated both skin and nail lesions from the time of diagnosis. Most nail lesions resolved within a mean of four months of the initiation of treatment.. Nail involvement in LS is rare; this case series highlights the associated nail changes. We emphasize that early accurate diagnosis and treatment may be beneficial in reducing nail deformities in patients with nail involvement.

Topics: Adrenal Cortex Hormones; Adult; Child; Child, Preschool; Drug Therapy, Combination; Female; Foot Dermatoses; Hand Dermatoses; Humans; Immunosuppressive Agents; Lichenoid Eruptions; Male; Nail Diseases; Tacrolimus; Triamcinolone Acetonide

Dematiaceous molds are increasingly recognized as important human pathogens. We report 2 cases of cutaneous phaeohyphomycosis in renal allograft recipients, caused by Alternaria alternata and Curvularia spp., respectively, which demonstrate the diversity in clinical presentation, the different therapeutic strategies, and the clinical importance of azole antifungal-induced drug-drug interactions with immunosuppressive therapy.

Topics: Aged; Alternaria; Antifungal Agents; Ascomycota; Azoles; Dermatomycoses; Drug Interactions; Drug Therapy, Combination; Female; Hand Dermatoses; Humans; Immunocompromised Host; Immunosuppression Therapy; Kidney Transplantation; Leg Dermatoses; Male; Middle Aged; Opportunistic Infections; Tacrolimus

Pimecrolimus is a calcineurin inhibitor developed for the topical therapy of inflammatory skin diseases, particularly atopic dermatitis (AD). Pimecrolimus selectively targets T cells and mast cells. Pimecrolimus inhibits T-cell proliferation, as well as production and release of interleukin-2 (IL-2), IL-4, interferon-gamma and tumour necrosis factor-alpha. Moreover, pimecrolimus inhibits mast cell degranulation. In contrast to tacrolimus, pimecrolimus has no effects on the differentiation, maturation and functions of dendritic cells. In contrast to corticosteroids, pimecrolimus does not affect endothelial cells and fibroblasts and does not induce skin atrophy. Given the low capacity of pimecrolimus to permeate through the skin, it has a very low risk of systemic exposure and subsequent systemic side-effects. In different randomised controlled trials, topical pimecrolimus as cream 1% (Elidel) has been shown to be effective, well tolerated and safe in both adults and children with mild to moderate AD. In addition, pimecrolimus has been successfully used in inflammatory skin diseases other than AD, including seborrheic dermatitis, intertriginous psoriasis, lichen planus and cutaneous lupus erythematosus.

Topics: Dermatitis; Dermatitis, Atopic; Hand Dermatoses; Humans; Immunosuppressive Agents; Ointments; Psoriasis; Skin Absorption; Tacrolimus

Acrodermatitis continua suppurativa of Hallopeau (ACS) is a rare pustular variant of psoriasis in which numerous treatment modalities have been used without any consistent long-term effect. We report for the first time two patients with ACS which was successfully treated with topical tacrolimus 0.1% ointment. Our observations raise hopes that this new treatment strategy for ACS may constitute a novel effective therapeutic option for this recalcitrant condition.

Topics: Acrodermatitis; Administration, Topical; Aged; Aged, 80 and over; Bandages; Drug Administration Schedule; Female; Foot Dermatoses; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Treatment Outcome

Efficacy and steroid sparing effects of pimecrolimus 1% cream in atopic dermatitis have been shown recently, but there is no data on efficacy in long term management of atopic hand dermatitis. This study aims to investigate the efficacy of pimecrolimus 1% cream as maintenance therapy in patients suffering from atopic hand dermatitis.. A double-blind vehicle controlled study in 40 adult patients with atopic hand dermatitis (IGA ≤ 3) comparing the efficacy of twice daily application of pimecrolimus 1% cream given as maintenance treatment versus vehicle over a 8 week period after clinical response (IGA ≤ 2) to a 1-3 week pre-treatment with mometasone fuorate 0.1% was performed. Primary endpoint was the time to relapse (IGA ≥ 3).. Thirty-six out of 40 patients were randomised to receive either pimecrolimus 1% (P) or vehicle cream (V). The number of patients with stable remission in patients randomised to pimecrolimus (53.8%) and vehicle (43.8%) did not achieve statistical significance between the groups (p = 0.41). Subgroup analysis of patients with initially moderate dermatitis (IGA = 3, n = 20) showed a trend towards a better outcome for the pimecrolimus group (stable remission P = 81.8% versus V = 55.6%) (p = 0.244).. Pimecrolimus 1% cream twice daily was not superior to vehicle in the sequential maintenance therapy of atopic hand dermatitis, but efficacy in moderate forms should be investigated in further studies.

Topics: Adolescent; Adult; Aged; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Female; Hand Dermatoses; Humans; Male; Middle Aged; Tacrolimus; Treatment Outcome; Young Adult

Chronic hand dermatitis is common and difficult to treat.. Our aim was to assess the efficacy of pimecrolimus cream 1% in mild-to-moderate chronic hand dermatitis.. Adult patients (n = 652) were randomized to pimecrolimus 1% or vehicle cream twice daily with overnight occlusion for 6 weeks, followed by a 6-week open-label pimecrolimus treatment. Primary efficacy was 5-point Investigators' Global Assessment of prospectively selected 'target hand' as treatment success (Investigators' Global Assessment 0 or 1) and treatment failure. Pruritus relief was also assessed.. Following double-blind phase treatment, target hand treatment success was achieved in 29.8 and 23.2% of the patients in the pimecrolimus and vehicle groups, respectively (p = 0.057). The proportion of patients experiencing pruritus relief was significantly higher in the pimecrolimus group compared to the vehicle group at all time points throughout the double-blind phase.. The groups were comparable with respect to treating disease signs. Pruritus relief, however, was significantly greater in the pimecrolimus group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Dermatologic Agents; Double-Blind Method; Emollients; Female; Hand Dermatoses; Humans; Male; Middle Aged; Pruritus; Severity of Illness Index; Tacrolimus; Treatment Outcome; Young Adult

Hand dermatitis is a chronic inflammatory skin disorder for which systemic immunosuppressive therapy is often needed. Topical treatments could complement the use of systemic corticosteroids.. To evaluate symptoms of hand dermatitis in subjects treated with a prednisone taper combined with topical tacrolimus 0.1% ointment versus vehicle.. Thirty-two subjects with moderate to severe hand dermatitis were enrolled in a randomized double-blind controlled trial. Subjects received a 3-week taper of prednisone and was randomized 2:1 to apply topical tacrolimus or its vehicle twice daily for 12 weeks. Disease severity was evaluated at baseline and at 5 follow-up visits (weeks 1-14). Any occurrence of relapse was recorded by patients.. Twenty-two of the 32 subjects (69%) had relapse of their disease. The mean time to recurrence for tacrolimus versus vehicle was 48 versus 39 days, respectively (P = .78). A greater improvement of induration (P = .003) and scaling (P = .003) for patients with tacrolimus compared to vehicle was detected, as well as subjective improvement (%) from week 1 to week 12 (P = .04) compared to vehicle. Improvement in erythema (P < .0001), fissuring (P = .0003), pruritus (P = .06), and investigator's global assessment (P < .0001) with tacrolimus was not found to exceed improvement with vehicle.. Small sample size provides limited power to detect differences in response.. Topical tacrolimus improves induration and scaling, and there is a trend suggesting it prolongs the time to recurrence.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Dermatitis, Atopic; Dermatitis, Contact; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Glucocorticoids; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Prednisone; Tacrolimus

Occupational hand dermatitis (OHD) is a common and often chronic condition. Usage of topical corticosteroids is limited in long-term therapy because of potential side-effects. New treatment options are highly appreciated.. To study efficacy and safety of tacrolimus in patients suffering from OHD.. In a prospective, open, multicentre study, 29 patients with OHD of predominantly mild-to-moderate severity were treated with tacrolimus ointment (Protopic 0.1%) during a 4-week active treatment period with twice daily application followed by a 2-month optional treatment period. Efficacy was evaluated by the use of a standardized hand eczema score and by clinical severity rating, conducted on all study visits (screening, baseline and weeks 2, 4, 6, and 12). Adverse events were recorded for safety evaluation.. The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Finally, 12 (44%) patients were clear of hand eczema. Worsening of the dermatitis occurred in 2 patients (7%). Clinical grading indicated improvement too. Overall tolerability was good.. Topical tacrolimus might be an efficacious treatment option for chronic OHD. Blinded and randomized controlled studies are necessary to confirm the results of this pilot study.

Topics: Administration, Cutaneous; Adult; Aged; Dermatitis, Occupational; Disease Susceptibility; Female; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Occupations; Prospective Studies; Severity of Illness Index; Tacrolimus; Treatment Outcome

A multicenter, randomized, vehicle-controlled, 3-week study was conducted in patients with chronic hand dermatitis (HD) of various etiologies and locations to identify subgroups particularly responsive to twice-daily application of pimecrolimus cream 1% with overnight occlusion. A total of 294 patients were randomized to the study. By the final visit on day 22, there was a trend toward greater clearance in patients who received pimecrolimus than in those treated with vehicle cream. An analysis of treatment success by various stratification factors was performed, and it was found that palmar involvement had notable impact on response (P = .033). Patients in the pimecrolimus group continued to improve throughout the study; however, in the vehicle group, improvement plateaued after 15 days. Pimecrolimus was well tolerated, with a low rate of application-site reactions such as burning. Pimecrolimus cream 1%, when used twice daily with overnight occlusion, may be of benefit in the management of chronic HD.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Dermatitis, Atopic; Double-Blind Method; Emollients; Female; Follow-Up Studies; Hand Dermatoses; Humans; Male; Middle Aged; Probability; Reference Values; Risk Assessment; Tacrolimus; Treatment Outcome

Pimecrolimus cream 1% (Elidel, SDZ ASM 981) is a novel, non-steroid inflammatory cytokine inhibitor, effective in the treatment of atopic dermatitis. Here, we evaluate the treatment of chronic hand dermatitis with pimecrolimus cream 1%.. To determine pimecrolimus blood concentrations, and evaluate the safety, tolerability and efficacy following application of pimecrolimus cream 1% to subjects with chronic hand dermatitis.. In this open-label, multiple-topical-dose, non-controlled, pharmacokinetic study, pimecrolimus cream 1% was applied twice daily to dorsal and palmar areas (affected and unaffected) of both hands. Evening applications (except day 8) were immediately followed by overnight occlusion (> or =6 h). Full pharmacokinetic profile (days 1, 8 and 22), trough concentrations (days 3 and 15), physical examinations, laboratory measurements and adverse events were recorded. Efficacy was assessed via Investigators' Global Assessment (IGA), total key signs and symptoms and the subject's overall self-assessment.. Twelve patients completed the study. The majority of pimecrolimus blood concentrations (73.6%) remained below the limit of quantitation (0.1 ng/ml). The maximum concentration observed was 0.91 ng/ml and the maximum area under the concentration-time curve from 0-12 h post dose was 7.6 ng.h/ml. Treatment was well tolerated locally and systemically. No serious adverse events occurred; 4/13 subjects showed a total of 6 adverse events at the application site: burning (n=4), and pruritus (n=2). No clinically relevant or drug-related changes were observed. Clear efficacy of the treatment was shown by all 3 assessment methods. Disease state at day 22 had improved in 11 (85%) subjects compared with baseline (IGA).. Twice daily topical treatment of moderate to severe chronic hand dermatitis with pimecrolimus cream 1% results in low pimecrolimus blood levels, is well tolerated, safe, and effective.

Topics: Administration, Topical; Adult; Biological Availability; Chronic Disease; Dermatitis, Atopic; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Maximum Tolerated Dose; Middle Aged; Ointments; Tacrolimus; Treatment Outcome

Hand and foot eczema is a chronic skin disorder. Although topical corticosteroids are often used to control the predominant symptoms of the disease, the chronicity of the condition increases the risk of long-term adverse effects. A safer alternative is needed.. To evaluate the safety and efficacy of tacrolimus ointment 0.1% in hand and/or foot eczema.. Twenty-five adults applied tacrolimus ointment 0.1% to affected areas three times daily for 8 weeks and were followed for 2 additional weeks.. Except for vesiculation, compared with baseline there were significant improvements in erythema, scaling, induration, fissuring, composite severity, and pruritus (p<0.007). Two weeks after discontinuing treatment, significant improvement in scaling and composite severity (p<0.03) persisted, whereas erythema, induration, vesiculation, fissuring, and pruritus had returned to pre-treatment levels.. Tacrolimus ointment 0.1% is a promising corticosteroid alternative for hand/foot eczema.

Topics: Administration, Topical; Adult; Eczema; Female; Foot Dermatoses; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Pilot Projects; Statistics, Nonparametric; Tacrolimus; Treatment Outcome

Dyshidrotic palmoplantar eczema is a frequent disease often running a chronic relapsing course. Topical glucocorticosteroids form the mainstay of therapy, and alternatives are urgently warranted.. This study was performed to compare the efficacy of tacrolimus (FK506) 0.1% ointment and mometasone furoate 0.1% ointment in the treatment of dyshidrotic palmoplantar eczema.. Sixteen patients were included in the study after a randomized, observer-blind, intrapersonal comparison protocol. After a 2-week washout period, the active treatment phase amounted to 4 weeks with twice-daily topical application of test substances and additional use of emollients at will. Thereafter, patients were monitored at weekly intervals up to 8 weeks.. The dyshidrotic area and severity index showed a more than 50% reduction of baseline values after 2 weeks of active treatment both for FK506 (P =.003) and mometasone furoate (P =.022) in palmar areas. After active treatment, a nonsignificant increase in the dyshidrotic area and severity index was seen with FK506 treated areas. Fourteen of 16 patients had recurring symptoms requiring further therapy within 3 weeks after the active treatment phase.. Treatment with FK506 offers the possibility for rotational therapy with mometasone furoate in long-standing cases of chronic dyshidrotic palmar eczema.

Topics: Administration, Cutaneous; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Eczema, Dyshidrotic; Female; Foot Dermatoses; Glucocorticoids; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Mometasone Furoate; Pregnadienediols; Severity of Illness Index; Single-Blind Method; Tacrolimus; Treatment Outcome

Autoantibodies to melanoma differentiation-associated protein 5 (MDA5) are associated with a subset of patients with dermatomyositis (DM) who have rapidly progressive interstitial lung disease (RP-ILD) with poor prognosis. Intensive immunosuppressive therapy is initiated before irreversible lung damage can occur; however, there are few lines of evidence for the treatment of RP-ILD. Here, we report three cases of anti-MDA5 antibody-associated DM with RP-ILD in which the patients were treated with combined-modality therapy, including high-dose prednisolone, tacrolimus, intravenous cyclophosphamide and intravenous immunoglobulin (IVIG). In all three cases, serum ferritin levels, which are known to represent the disease activity of RP-ILD, were decreased after IVIG administration. IVIG might contribute to the control of the disease activity of anti-MDA5 antibody-positive DM. Moreover, palmar violaceous macules/papules around the interphalangeal joints, which was observed in all three cases in the incipient stage, might be a useful sign in suggesting a diagnosis of anti-MDA5 antibody-associated DM.

Topics: Aged; Anti-Inflammatory Agents; Autoantibodies; Combined Modality Therapy; Cyclophosphamide; Dermatomyositis; Female; Hand Dermatoses; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Interferon-Induced Helicase, IFIH1; Lung Diseases, Interstitial; Male; Middle Aged; Prednisolone; Tacrolimus; Treatment Outcome

Our patient's history of obsessive-compulsive disorder may have masked the true diagnosis for years.

Topics: Family Practice; Hand; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Medical History Taking; Middle Aged; Protoporphyria, Erythropoietic; Sunlight; Tacrolimus

Topics: Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Neck; Rare Diseases; Scleromyxedema; Tacrolimus; Treatment Failure

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

Topics: Betamethasone; Glucocorticoids; Hand Dermatoses; Humans; Immunosuppressive Agents; Keratoderma, Palmoplantar; T-Lymphocyte Subsets; Tacrolimus

Topics: Administration, Topical; Child, Preschool; Follow-Up Studies; Hand Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Male; Nails, Malformed; Risk Assessment; Tacrolimus; Treatment Outcome

The ulcerative variant of lichen planus (LP) commonly involves the oral mucosa but is uncommon and difficult to treat when located on other areas. We describe an unusual case of ulcerative LP involving several surfaces, including the palms and scrotum, in a 50-year-old man with hepatitis C. The patient was recalcitrant to treatment with conventional therapy but obtained clearance with a sustained response using low molecular weight heparin (LMWH). This treatment is an option for patients with LP who are not ideal candidates for standard therapy.

Topics: Anti-Inflammatory Agents; Anticoagulants; Clobetasol; Genital Diseases, Male; Hand Dermatoses; Heparin, Low-Molecular-Weight; Hepatitis C; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Scrotum; Skin Ulcer; Tacrolimus

Topics: Administration, Topical; Ainhum; Dermatologic Agents; Female; Hand Dermatoses; Humans; Infant; Psoriasis; Tacrolimus; Ultraviolet Therapy

Acrodermatitis continua of Hallopeau (ACH) is a rare type of pustular psoriasis affecting the digits. We report on a 43-year-old female patient who had been suffering from ACH for more than 20 years. Despite the fact that the disease was localized on one finger during the whole period, several topical and systemic treatments resulted in only temporary or partial improvement of the lesion. Although the monotherapies with calcipotriol and tacrolimus ointments gave no satisfying results in the long-term management of the disease, the combination of both agents led to a continuous improvement of the patient's skin condition.

Topics: Acrodermatitis; Administration, Cutaneous; Adult; Calcitriol; Dermatologic Agents; Drug Combinations; Female; Hand Dermatoses; Humans; Immunosuppressive Agents; Ointments; Psoriasis; Tacrolimus

Hand dermatitis is a common chronic skin condition that has many clinical forms including contact, hyperkeratotic, frictional, nummular, atopic, pompholyx and chronic vesicular hand dermatitis. Topical steroids are the first line agents used. Here, we report the successful response to topical pimecrolimus 1% cream in a patient with steroid resistant chronic vesicular hand dermatitis.

Topics: Administration, Topical; Chronic Disease; Female; Follow-Up Studies; Hand Dermatoses; Humans; Middle Aged; Severity of Illness Index; Skin Diseases, Vesiculobullous; Tacrolimus; Treatment Outcome

Topics: Calcineurin Inhibitors; Eczema; Foot Dermatoses; Hand Dermatoses; Humans; Immunosuppressive Agents; Tacrolimus

Topics: Aged; Aged, 80 and over; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Pemphigoid, Bullous; Tacrolimus