tacrolimus and Pemphigoid--Benign-Mucous-Membrane

Inflammatory mucosal disorders are treated conventionally with potent or superpotent topical corticosteroids. For more than 20 years, topical cyclosporine has been used in the management of oral mucous membrane affections. Recently other topically applied calcineurin inhibitors, namely tacrolimus and pimecrolimus, expanded the armamentarium for the treatment of inflammatory mucosal diseases. This chapter places its main emphasis on the efficacy and safety of topical calcineurin inhibitors in the management of different oral and genital conditions, including anogenital lichen sclerosus (LS), oral and genital lichen planus, plasma cell balanitis and vulvitis, mucous membrane pemphigoid and pemphigus vulgaris, all conditions having usually a protracted course, requiring long-lasting treatment. There is current evidence for the effectiveness of both pimecrolimus and tacrolimus in the topical treatment of inflammatory oral mucosal diseases and genital dermatoses, especially oral lichen planus and genital LS.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Balanitis; Calcineurin Inhibitors; Carcinogens; Female; Genital Diseases, Female; Humans; Lichen Planus; Lichen Planus, Oral; Lichen Sclerosus et Atrophicus; Male; Mucositis; Paraneoplastic Syndromes; Pemphigoid, Benign Mucous Membrane; Pemphigus; Tacrolimus; Vulvitis

In this review we summarize selected articles that have been published about immunosuppressive agents in the past year. These studies fall into three major categories: 1) use of pulse cyclophosphamide in autoimmune diseases other than systemic lupus erythematosus; 2) use of newer immunosuppressive agents such as cyclosporine and FK506 in a variety of rheumatic diseases; and 3) toxicity.

Topics: Adult; Arthritis, Juvenile; Azathioprine; Behcet Syndrome; Child; Cladribine; Cyclophosphamide; Cyclosporine; Drug Therapy, Combination; Granulomatosis with Polyangiitis; Humans; Hydroxychloroquine; Immunosuppressive Agents; Liver; Lung; Lung Injury; Lupus Erythematosus, Systemic; Methotrexate; Pemphigoid, Benign Mucous Membrane; Retina; Tacrolimus; Thalidomide

To evaluate the efficacy of tacrolimus (FK 506) therapy in patients with ocular cicatricial pemphigoid (OCP).. In a cohort study, six patients with OCP, in whom the disease was not controlled by conventional immunosuppressive agents administered in high doses for an appropriate period of time, were treated with FK 506. The FK 506 was administered orally at the daily dose of 8 mg. Final clinical response to FK 506 was divided into three categories based on the difference between severity of conjunctival inflammation before and after FK 506 therapy. "Total control" of disease activity was defined as residual inflammatory activity of 0.5 or less in the final examination and an inflammation decrement of at least 0.5 between initial and final examination. "Partial control" was defined as final disease activity 1.0 or 1.5 and at least 0.5 decrement of disease activity between initial and final examination. "Uncontrolled inflammation" was defined as final disease activity above 1.5 or no improvement between initial and final activity.. The average age of the patients was 67.5 years (range 50-75 years). Male to female ratio was 1:1. The average duration of OCP prior to beginning of FK 506 treatment was 6.25 years (range 3-12.5 years). The average duration of treatment with FK 506 was 11 months (range 5-18 months). The average disease activity prior to the administration of FK 506 was 2.6 (range 2.0-3.0). The average disease activity at the time when FK 506 was stopped was 2.0 (range 1.0-2.5). In four patients (67%) FK 506 failed to control activity of OCP, and in two patients (33%) the activity was controlled partially.. Although FK 506 was not used in a prospective randomized trial and although we used the drug only in patients with OCP refractory to conventional immunosuppressive agents, it is likely that FK 506 is incapable of controlling the activity of OCP and inducing a remission.

Topics: Administration, Oral; Aged; Cohort Studies; Conjunctivitis; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Pemphigoid, Benign Mucous Membrane; Tacrolimus; Treatment Outcome

Topics: Adult; Aged; Aged, 80 and over; Autoantibodies; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Male; Middle Aged; Pemphigoid, Benign Mucous Membrane; Retrospective Studies; Steroids; Tacrolimus

Topics: Administration, Topical; Aged, 80 and over; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Tacrolimus

Topics: Administration, Topical; Aged, 80 and over; Biopsy; Humans; Immunosuppressive Agents; Male; Mouth Mucosa; Mouthwashes; Pemphigoid, Benign Mucous Membrane; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Female; Humans; Immunosuppressive Agents; Middle Aged; Pemphigoid, Benign Mucous Membrane; Tacrolimus; Treatment Outcome; Vulvar Diseases

Topics: Administration, Topical; Aged; Female; Gingival Diseases; Humans; Immunosuppressive Agents; Male; Mouth Diseases; Pemphigoid, Benign Mucous Membrane; Tacrolimus

Topics: Administration, Topical; Aged; Eye Diseases; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Pemphigoid, Benign Mucous Membrane; Pemphigus; Tacrolimus