tacrolimus and Neurodermatitis

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

Pruritus vulvae may have a variety of causes, such as infections, dermatologic disorders or non-neoplastic/neoplastic vulvar diseases.. To investigate the efficacy and side effects of topical pimecrolimus 1% cream for pruritus vulvae.. Twelve postmenopausal diabetic women with vulvar lichen simplex chronicus were enrolled in this trial. Each patient was treated with pimecrolimus 1% cream which was applied twice daily in a thin layer to the vulvae for 3 months. Clinical examination and recording of patients' symptoms using a scoring system was performed by the same physician before, after 4 weeks and after 3 months of therapy.. All of the patients completed the study. A substantial decrease in pruritus after treatment was reported by the patients at the 4th week (2.17+/-0.72, p<0.01) and 3rd month of treatment (0.42+/-0.92, p<0.001) when compared with the baseline score (3.75+/-0.45). Follow-up of the patients after 3 months of treatment showed that complete cure occurred in 10 patients (83.3%) and the pruritus was improved in two (16.7%) patients.. Pimecrolimus 1% cream seems to be an effective and safe treatment modality for pruritus in postmenopausal women with vulvar lichen simplex chronicus.

Topics: Adult; Aged; Dermatologic Agents; Diabetes Complications; Female; Humans; Middle Aged; Neurodermatitis; Postmenopause; Prospective Studies; Pruritus Vulvae; Tacrolimus

To evaluate efficacy and safety of pimecrolimus cream 1% twice daily for treatment of vulvar lichen simplex chronicus (LSC).. Patients in this 12-week, open-label study had biopsy-proven vulvar LSC. Inclusion criteria were patient-reported Visual Analog Scale for Pruritus Relief > or = 3 (VAS-PR, 0 cm = no itching to 10 cm = severe itching) and Investigator's Global Assessment > or = 2 (IGA, 0 = no disease to 3 = severe disease). Safety was evaluated by adverse event reports and pimecrolimus blood level measurements.. Twelve women aged 25-53 years were enrolled. The median pruritus score (VAS-PR) decreased from 6 (min. 4.9, max. 9.0) at baseline to 0 cm at week 4 (max. 4.2), week 8 (max. 3.1) and week 12 (max. 2.1). Seven patients reported complete resolution of pruritus by week 4. Median IGA decreased from 2.5 (min. 2, max. 3) at baseline to 0 (min. 0, max. 2) at week 12. Erythema, excoriation, and lichenification improved for all patients. Pimecrolimus blood concentration for all samples was below the limit of quantification, 0.3 ng/ml. No adverse events were reported.. In this exploratory study, signs and symptoms of vulvar LSC improved for all women and pimecrolimus cream showed a favorable safety profile. Larger prospective studies are needed to further evaluate pimecrolimus for treatment of vulvar LSC.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Middle Aged; Neurodermatitis; Severity of Illness Index; Tacrolimus; Treatment Outcome; Vulvar Diseases

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Humans; Immunosuppressive Agents; Male; Middle Aged; Neurodermatitis; Scrotum; Tacrolimus; Young Adult

Tinea incognito was first described 50 years ago. It is a dermatophytic infection with a clinical presentation modified by previous treatment with topical or systemic corticosteroids, as well as by the topical application of immunomodulators such as pimecrolimus and tacrolimus. Tinea incognito usually resembles neurodermatitis, atopic dermatitis, rosacea, seborrheic dermatitis, lupus erythematosus, or contact dermatitis, and the diagnosis is frequently missed or delayed.

Topics: Administration, Cutaneous; Antifungal Agents; Dermatitis, Atopic; Dermatitis, Contact; Dermatitis, Seborrheic; Dermatologic Agents; Diagnosis, Differential; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Neurodermatitis; Ointments; Rosacea; Tacrolimus; Tinea; Trichophyton

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

Topics: Child; Clinical Trials as Topic; Dermatologic Agents; Humans; Neurodermatitis; Nursing Assessment; Quality of Life; Stress, Psychological; Tacrolimus

Topics: Anti-Inflammatory Agents; Glucocorticoids; Humans; Immunosuppressive Agents; Neurodermatitis; Quality of Life; Tacrolimus

Topics: Administration, Topical; Anti-Inflammatory Agents, Non-Steroidal; Cortisone; Drug Administration Schedule; Drug Therapy, Combination; Humans; Neurodermatitis; Tacrolimus; Treatment Outcome

Topics: Child; Child, Preschool; Dose-Response Relationship, Drug; Humans; Hydrocortisone; Immunosuppressive Agents; Infant; Neurodermatitis; Tacrolimus; Urticaria

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents, Non-Steroidal; Calcineurin Inhibitors; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Neurodermatitis; Tacrolimus