tacrolimus and Precancerous-Conditions

Oral lichen planus (OLP) is a chronic mucosal condition commonly encountered in clinical dental practice. Lichen planus is believed to represent an abnormal immune response in which epithelial cells are recognized as foreign, secondary to changes in the antigenicity of the cell surface. It has various oral manifestations, the reticular form being the most common. The erosive and atrophic forms of OLP are less common, yet are most likely to cause symptoms. Topical corticosteroids constitute the mainstay of treatment for symptomatic lesions of OLP. Recalcitrant lesions can be treated with systemic steroids or other systemic medications. However, there is only weak evidence that these treatments are superior to placebo. Given reports of a slightly greater risk of squamous cell carcinoma developing in areas of erosive OLP, it is important for clinicians to maintain a high index of suspicion for all intraoral lichenoid lesions. Periodic follow-up of all patients with OLP is recommended.

Topics: Carboxymethylcellulose Sodium; Carcinoma, Squamous Cell; Chronic Disease; Diagnosis, Differential; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Mouth Neoplasms; Precancerous Conditions; Steroids; Tacrolimus

The course of inflammatory bowel disease after liver transplantation has been reported as variable with usually no change or improvement, but there may be an increased risk of early colorectal neoplasms. In many centres steroids are often withdrawn early after transplantation and this may affect inflammatory bowel disease activity.. To evaluate the course of inflammatory bowel disease in primary sclerosing cholangitis transplant patients who were treated without long term steroids.. Between 1989 and 1996, there were 30 patients transplanted for primary sclerosing cholangitis who survived more than 12 months. Ulcerative colitis was diagnosed in 18 (60%) patients before transplantation; two had previous colectomy. All patients underwent colonoscopy before and after transplantation and were followed for 38 (12-92) months. All received cyclosporin or tacrolimus with or without azathioprine as maintenance immunosuppression.. Ulcerative colitis course after transplantation compared with that up to five years before transplantation was the same in eight (50%) and worse in eight (50%) patients. It remained quiescent in eight and worsened in four of the 12 patients with pretransplant quiescent course, whereas it worsened in all four patients with pretransplant active course (p=0.08). New onset ulcerative colitis developed in three (25%) of the 12 patients without inflammatory bowel disease before transplantation. No colorectal cancer has been diagnosed to date.. Preexisting ulcerative colitis often has an aggressive course, while de novo ulcerative colitis may develop in patients transplanted for primary sclerosing cholangitis and treated without long term steroids.

Topics: Adolescent; Adult; Cholangitis, Sclerosing; Colitis, Ulcerative; Cyclosporine; Female; Graft Survival; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Precancerous Conditions; Risk Factors; Tacrolimus

Vulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms.. The purpose of this clinical guide is to provide advice on early recognition and treatment.. Literature review and consensus of expert opinion.. The etiology of LS in peri and postmenopausal women is unknown, although autoimmune, genetic and infectious factors have been implicated. Definitive diagnosis of non-malignant disorders depends on the histology of biopsied tissue. LS associated with cellular atypia should be classified as intraepithelial neoplasia. Topical corticosteroids are the most effective treatment, although prolonged treatment may be associated with dermal atrophy. Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, may be a safe and effective alternative treatment without risk of corticosteroid-related vulvar atrophy since they do not affect collagen synthesis. LS recurrences are frequent, and can lead to significant physical discomfort and emotional distress that affect mood and sexual relationships. Anatomical changes may require surgical management.

Topics: Adrenal Cortex Hormones; Calcineurin Inhibitors; Early Diagnosis; Female; Humans; Perimenopause; Postmenopause; Precancerous Conditions; Tacrolimus; Vulvar Diseases; Vulvar Lichen Sclerosus

To evaluate disease dynamics, treatment results, and frequency of malignant transformation. Ten-year single center retrospective study. The study included 171 patients, 28-99 years old. Follow-up was 1-16 years. 49.5% exhibited changes in clinical presentation, with 19% yearly increase of probability for type shift. Index of extent (number of oral locations) showed a mean 40% decrease and 94.1% reported improvement. There were significant differences between treated and untreated patients (P=0.012). Patients with or without systemic diseases had identical treatment requirements for oral lesions. The prevalence of SCC was 5.8%. Oral lichen planus constantly changes presentation and extent of involvement. The effect of systemic diseases was insignificant in the present study. There is a clear value for treatment to reduce the extent of lesions. The results indicate that all clinical forms of the disease need to be equally followed since the clinical presentation typically changes over time, while malignant transformation can occur in all forms.

Topics: Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Clobetasol; Dexamethasone; Female; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Neoplasms; Precancerous Conditions; Prednisone; Prevalence; Retrospective Studies; Tacrolimus; Tretinoin; Triamcinolone

Topics: Female; Humans; Immunosuppressive Agents; Keratinocytes; Precancerous Conditions; Proto-Oncogene Proteins c-bcl-2; Tacrolimus; Tumor Suppressor Protein p53; Vulvar Lichen Sclerosus

Topics: Administration, Topical; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Lichen Sclerosus et Atrophicus; Precancerous Conditions; Risk Assessment; Skin Neoplasms; Tacrolimus; Vulvar Diseases

Immunomodulators include both immunostimulatory and immunosuppressive agents. Obligate contact sensitizers such as diphencyprone or dinitrochlorobenzene have been used against viral and autoimmune diseases. Newer agents such as the toll-like receptor agonists imiquimod and resiquimod have been clinically used to treat viral infections and skin cancers in immunocompetent and immunosuppressed patients. On the other hand, the topical immunosuppressive agents tacrolimus and pimecrolimus have been used with great success in the treatment of chronic inflammatory diseases in children and adults. The introduction of this new class of drugs (i.e. Calcineurin inhibitors) marked the beginning of the post-cortisone era in clinical dermatology. Toll-like receptor agonists and calcineurin antagonists will supplement corticosteroids to improve specific dermatological therapy. Topical immunotherapy with both immunostimulatory and immunosuppressive agents show potential for effective and patient-friendly treatment of inflammatory, infectious and neoplastic skin diseases. Long-term evaluation will define the tolerability and the safety profile.

Topics: Adjuvants, Immunologic; Administration, Topical; Adult; Aged; Aged, 80 and over; Aminoquinolines; Asthma; Autoimmune Diseases; Bowen's Disease; Child; Cyclopropanes; Dermatitis, Atopic; Dinitrochlorobenzene; Female; Follow-Up Studies; Herpes Simplex; Humans; Imidazoles; Imiquimod; Immunity, Cellular; Immunocompromised Host; Immunoglobulin A; Immunosuppressive Agents; Lichen Sclerosus et Atrophicus; Male; Molluscum Contagiosum; Papillomavirus Infections; Precancerous Conditions; Skin Diseases; Skin Diseases, Viral; Skin Neoplasms; Tacrolimus; Time Factors; Warts

During the time 1989 to 1992 we collected PAP smears of 58 women before and several times after a liver transplantation. Five of the patients (= 8.6%) showed a suspicious PAP smear, although pre-transplantation they had a normal cervical cytology. Histological one woman even had a higher grade dysplasia. 30 women received FK 506 after the liver transplantation, 28 patients Cyclosporin A as long-term medication. Likewise kidney and liver transplanted women have a higher risk to be affected by a cervical neoplasia. A acceleration of malignant growth seems to be likely. The influence on the cervical cells of both immunosuppressive drugs Cyclosporin A (Sandimmun) and FK 506 seem to be similar. It should be recommended to perform a close-meshed cervical cytology control when following -up the female liver transplant recipients.

Topics: Adolescent; Adult; Aged; Cervix Uteri; Cyclosporine; Female; Follow-Up Studies; Humans; Liver Transplantation; Middle Aged; Neoplasm Staging; Papanicolaou Test; Postoperative Complications; Precancerous Conditions; Risk Factors; Smoking; Tacrolimus; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vaginal Smears

Topics: Animals; Biomarkers, Tumor; Carcinogens; Diethylnitrosamine; Glutathione Transferase; Liver; Liver Neoplasms; Male; Precancerous Conditions; Rats; Rats, Inbred F344; Tacrolimus