tacrolimus and Leg-Ulcer

Tacrolimus, a calcineurin inhibitor, has become an increasingly valuable tool in the treatment of dermatological disorders during the last few years. However, its effect on wound healing is still under investigation and remains the subject of safety concerns. A 75-year old woman with lichen planus, diabetes mellitus, and a foot ulcer was prescribed tacrolimus for the treatment of her lichen planus. After starting the treatment, her ulcer healed and the medication was discontinued. Shortly thereafter, re-ulceration occurred, treatment was re-introduced, and the wound continued to heal until treatment was discontinued. When the third course of tacrolimus was prescribed, the ulcer started healing again but a diagnosis of osteomyelitis necessitated surgical intervention. A review of the literature suggests that tacrolimus does not adversely affect healing in vivo or in vitro and may facilitate healing lower extremity skin ulcers, especially those of inflammatory origin. Studies are needed to clarify which lower extremity wounds would improve with tacrolimus.

Topics: Aged; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Tacrolimus; Wound Healing

Pyoderma gangrenosum (PG) is a type of neutrophilic disorder with a chronic clinical course. Immunosuppressive agents have been used for its management. Among them, corticosteroid is known as the most effective. However, other immunosuppressants including cyclosporine A have been selected for patients with PG who were refractory to systemic steroids. Herein we report a case of PG resistant to systemic steroids, who was successfully treated with topical tacrolimus. A fifty-four year-old male had a 14-year history of PG. In 2002, necrotic ulcers appeared on his right leg that were refractory to oral prednisolone (30 mg/day). The application of topical tacrolimus to the border of the ulcers hastened epithelization of the ulcers and allowed for reduction of the oral prednisolone. Topical tacrolimus therapy may be an effective alternative for PG when the lesion is poorly controlled by corticosteroid.

Topics: Administration, Topical; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Middle Aged; Pyoderma Gangrenosum; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome

An 81-year-old male patient with a history of peripheral arterial disease (PAD) was admitted to the authors' outpatient clinic with a painful lower leg ulcer. As the degree of PAD did not correspond to the clinical findings, multiple biopsies were taken from the base and edge of the ulcer. This resulted in the histopathological and clinical diagnosis of pyoderma gangrenosum (PG). Since PG is often associated with numerous underlying diseases, further thorough examinations were performed. A mass in the gastric antrum suspicious for malignancy was histopathologically identified as gastric cancer (signet ring cell carcinoma). The PG was successfully treated with cortisone p.o. and tacrolimus ointment. Since the cancer was locally limited, the patient underwent surgery involving gastric resection with D2 lymphadenectomy and gastrojejunostomy (Roux-en‑Y anastomosis).. Ein 81-jähriger Patient mit einer vorbekannten peripheren arteriellen Verschlusskrankheit (pAVK) stellte sich mit einem sehr schmerzhaften Ulcus cruris in unserer Gefäßambulanz vor. Da das Ausmaß der pAVK nicht zum klinischen Bild passte, wurden Biopsien aus dem Ulkusgrund und -rand entnommen. Die Aufarbeitung führte zur histopathologischen und klinischen Diagnose eines Pyoderma gangraenosum (PG). Da das PG häufig auf eine Grunderkrankung zurückzuführen ist, wurde eine ausführliche Umfelddiagnostik durchgeführt. In der Gastroskopie konnte eine malignomverdächtige Raumforderung im Antrum schließlich histopathologisch als Siegelzellkarzinom des Magens identifiziert werden. Das PG konnte erfolgreich mit Prednison p.o. und lokal applizierter Tacrolimussalbe behandelt werden. Bei lokal begrenztem Tumorgeschehen erfolgte eine Magenresektion mit D2-Lymphadenektomie und Roux-Y-Gastrojejunostomie.

Topics: Aged, 80 and over; Humans; Leg Ulcer; Male; Pyoderma Gangrenosum; Tacrolimus

Prolidase deficiency is a rare autosomal recessive disorder characterized by cutaneous ulcers, facial dysmorphism, recurrent infections, and intellectual disability. We report a unique case of a 6-year-old boy with prolidase deficiency and Crohn's disease who presented with lower extremity ulcers. Cutaneous ulcers due to prolidase deficiency are historically resistant to treatment, and we report success with the novel use of topical tacrolimus.

Topics: Administration, Topical; Calcineurin Inhibitors; Child; Humans; Leg Ulcer; Male; Ointments; Prolidase Deficiency; Tacrolimus

To report a case of refractory ulcerated necrobiosis lipoidica (NL) with significant response to treatment with topical tacrolimus.. A 55-year-old woman without diabetes and with a previous history of NL presented to the Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center of NYU Langone Medical Center, New York, with bilateral lower-leg ulcerations resistant to wound healing techniques at other institutions.. Repeat biopsy performed at the author's institution confirmed the diagnosis of NL. Initial therapy was based on reports of other successful treatment methods, which included collagen wound grafts and collagen-based dressings coupled with compression. These methods initially showed promising results; however, the wounds reulcerated, and any gains in wound healing were lost. Alternative options were initiated, including topical clobetasol and narrowband ultraviolet B; however, no significant improvement was observed. The patient's lower-extremity wounds began to deteriorate. The patient also refused systemic therapy. Treatment was changed to topical 0.1% tacrolimus ointment and was applied daily for 10 months with multilayer compression wraps.. Both lower-extremity ulcerations began to show significant improvement, with the ulcers progressing toward closure except for 1 very small area on the left lower extremity.. Topical tacrolimus seems to be an effective treatment option for patients with refractory chronic ulcerated NL who do not want systemic oral therapy. The authors found that successful wound closure may require a multimodal approach, which promotes wound healing, but also concurrently addresses the underlying disease process.

Topics: Administration, Topical; Biopsy, Needle; Chronic Disease; Compression Bandages; Female; Follow-Up Studies; Humans; Immunohistochemistry; Leg Ulcer; Long-Term Care; Middle Aged; Necrobiosis Lipoidica; Severity of Illness Index; Tacrolimus; Treatment Outcome; Wound Healing

Necrobiosis lipoidica presents with a distinctive appearance making it an important clinical diagnosis.. To describe a case of necrobiosis lipoidica in a patient with type 1 diabetes mellitus, and to discuss differential diagnoses and management.. Necrobiosis lipoidica is most commonly found on the shins, presenting as a well-defined plaque. Management is challenging and options are discussed. Avoiding ulceration is a key concern.

Topics: Adult; Diabetes Mellitus, Type 1; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Necrobiosis Lipoidica; Risk Factors; Tacrolimus

Topics: Administration, Topical; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Middle Aged; Ointments; Tacrolimus; Time Factors; Treatment Outcome; Wound Healing

Topics: Administration, Topical; Child; Colitis; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Aged; Arthritis, Rheumatoid; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Retreatment; Tacrolimus

Topics: Adult; Female; Foot Ulcer; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Middle Aged; Pyoderma Gangrenosum; Tacrolimus