tacrolimus and Skin-Ulcer

Pyoderma gangrenosum is an inflammatory disease that has been found to be associated with many systemic illnesses. The case presented here is of a man with a 20-year history of hidradenitis suppurativa who developed pyoderma gangrenosum. The pyoderma lesions appeared as a single outbreak which resolved totally after immunosuppressive treatment. This association has been reported only rarely in the literature. Furthermore, in the cases reported, no relationship was apparent between the activity of both diseases. In all cases the clinical course appeared independent, with no apparent overlap in inflammatory activity or response to the drugs administered.

Topics: Abscess; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antibodies, Monoclonal; Cyclosporine; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Infliximab; Male; Middle Aged; Pyoderma Gangrenosum; Retinoids; Skin Ulcer; Tacrolimus

Reports of cases of mycobacterial infections after SCT are rare. We report a 30-year-old female with a cutaneous infection of Mycobacterium fortuitum 30 months after allogeneic bone marrow transplantation for acute lymphoblastic leukemia. The patient was successfully treated with surgical debridement followed by oral minocycline and clarithromycin. Mycobacterial infections should be considered in SCT patients with undiagnosed refractory chronic cutaneous infection, and surgical debridement is useful for the diagnosis and treatment of such infections.

Topics: Adult; Bone Marrow Transplantation; Clarithromycin; Combined Modality Therapy; Cyclosporine; Debridement; Drug Therapy, Combination; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Immunosuppressive Agents; Methotrexate; Minocycline; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Remission Induction; Skin Ulcer; Tacrolimus; Transplantation Conditioning; Transplantation, Homologous

Several treatment modalities had been used for the treatment of vitiligo, but the optimal treatment has not yet been identified.. To study the efficacy of microneedling with 5-flurouracil vs its efficacy with tacrolimus in the treatment of vitiligo.. Twenty-five patients with vitiligo were subjected to microneedling of 2 patches of vitiligo with dermapen, then application of 5-fluorouracil to 1 patch and tacrolimus on the other patch. This procedure was repeated every 2 weeks for every patient for maximum 6 months (12 sessions). The patients were followed up for 3 months after the last session.. The overall repigmentation was significantly higher in 5-fluorouracil-treated patches compared with tacrolimus. Excellent improvement occurred in 48% of 5- flurouracil-treated patches while only in 16% of tacrolimus-treated patches. In the acral parts, 40% of the patches treated with 5-fluorouracil achieved excellent improvement (repigmentation >75%), while no patch in the acral parts achieved excellent improvement with tacrolimus. However, there was significant difference between the 2 drugs,regarding inflammation, ulceration, and hyperpigmentation which occurred with 5-fluorouracil.. Microneedling combined with 5-fluorouracil or tacrolimus is safe and effective treatment of vitiligo. However, 5-fluorouracil achieved a greater percentage of repigmentation than tacrolimus particularly in the acral parts.

Topics: Administration, Cutaneous; Cosmetic Techniques; Dermatologic Agents; Female; Fluorouracil; Humans; Hyperpigmentation; Immunosuppressive Agents; Inflammation; Male; Needles; Occlusive Dressings; Skin Ulcer; Tacrolimus; Treatment Outcome; Vitiligo; Young Adult

Topics: Aged; Animals; Anti-Bacterial Agents; Duodenal Diseases; Endoscopy, Digestive System; Fishes; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Multiple Pulmonary Nodules; Mycobacterium Infections, Nontuberculous; Mycophenolic Acid; Pets; Prednisone; Severity of Illness Index; Skin Ulcer; Tacrolimus; Tomography, X-Ray Computed; Zoonoses

Topics: Absorption, Physiological; Administration, Topical; Crohn Disease; Female; Humans; Immunosuppressive Agents; Middle Aged; Skin Ulcer; Tacrolimus

Topics: Antibodies; Dermatomyositis; Fingers; Humans; Immunosuppressive Agents; Interferon-Induced Helicase, IFIH1; Lung Diseases, Interstitial; Male; Middle Aged; Prednisone; Respiratory Function Tests; Skin Diseases, Papulosquamous; Skin Ulcer; Tacrolimus; Tomography, X-Ray Computed

Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.. We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.. This was a prospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence.. Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence.. Our study did not include a randomized comparator.. Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone.

Topics: Administration, Cutaneous; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Humans; Male; Medication Adherence; Middle Aged; Prospective Studies; Pyoderma Gangrenosum; Quality of Life; Recurrence; Skin Ulcer; Tacrolimus; Treatment Outcome

Topics: Adenocarcinoma; Aged; Colonic Neoplasms; Colostomy; Dermatitis; Diagnosis, Differential; Humans; Male; Postoperative Complications; Prednisone; Pyoderma Gangrenosum; Skin Neoplasms; Skin Ulcer; Surgical Stomas; Tacrolimus

The art of diagnosis consists in the recognition of signs and symptoms and their interpretation under the light of individual circumstances obtained from the patient's history. In medicine we encounter cases that are straightforward and cases that are complex as they are the result of a rare disease or of uncommon presentation of a common disorder. We present in this paper the case of a patient with a non-healing traumatic wound to her shin, which after unsuccessful treatments was biopsied and an unexpected diagnosis of necrobiosis lipoidica diabeticorum was made. This led to the institution of disease-targeted wound care leading to complete resolution in a short period of time.

Topics: Anemia, Sickle Cell; Female; Guidelines as Topic; Humans; Immunosuppressive Agents; Leg Injuries; Middle Aged; Necrobiosis Lipoidica; Skin Ulcer; Tacrolimus; Treatment Outcome; Wound Healing

Topics: Aged; Female; Foot Dermatoses; Humans; Immunosuppressive Agents; Lichen Planus; Skin Ulcer; Tacrolimus

Perforating granuloma annulare (PGA) is a rare subtype of granuloma annulare (GA) named in 1971 by Owens and Freeman. It is characterized by necrobiotic areas surrounded by histiocytes and lymphocytes with transepidermal elimination. Many treatments for PGA have been used, often with unsatisfactory results. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis; moreover, ample data exist which demonstrate the usefulness of tacrolimus for the specific treatment of other inflammatory diseases. We report a 70-year-old diabetic woman with PGA, in whom the ulceration due to PGA responded to 0.1% topical tacrolimus.

Topics: Administration, Cutaneous; Aged; Extremities; Female; Granuloma Annulare; Humans; Immunosuppressive Agents; Skin Ulcer; 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: Animals; Immunosuppressive Agents; Rabbits; Skin Ulcer; Tacrolimus; Transforming Growth Factor beta; Wound Healing

Topics: Adult; Humans; Male; Necrosis; Pyoderma; Skin Ulcer; Tacrolimus