Systemic ciclosporin and tacrolimus in dermatology

Madan, Vishal; Griffiths, C.E.M.

doi:10.1111/j.1529-8019.2007.00137.x

Cited by 75 publications

(58 citation statements)

References 84 publications

(125 reference statements)

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“…Oral lichen planus (OLP) affects 2% of the population with the highest incidence in women (2: 1), and the most affected age ranges from 40-70 years [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Topical Therapies for Oral Lichen Planus Management and their Efficacy: A Narrative Review

Bagán

Compilato²,

Paderni³

et al. 2012

CPD

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Oral Lichen Planus (OLP) is a chronic inflammatory condition implicating T cell-mediated cytotoxicity, and involving oral mucosal surfaces. Several therapeutic regimens have been evaluated to treat OLP and pain related, but often without high level of evidence. Topical formulations are the favourite for the majority of cases; bioadhesive formulations have been considered very useful and practical for local drug delivery in oral mucosa, due to the increased residence time on the oral mucosa of the dosage forms and better therapeutic efficacy.In this narrative review, authors try to illustrate the current topical managements for OLP from the accessible literature on this topic. Steroids are very helpful in discomfort and making better quality of life: they are considered the first-line treatment even if they could cause secondary candidosis, and sometimes bad taste, nausea, dry mouth, sore throat or swollen mouth.Other substances or devices by topical administration are adopted especially when the first line approach is refractory. This is the case when retinol with its synthetic and natural analogues (retinoids), hyaluronic acid, or Aloe Vera are chosen.Recent topical applications for OLP therapy include phototherapy and low/high energy pulsing light; the treatment with extracorporeal photochemotherapy is also reasonable and promising.Finally, calcineurin inhibitors (i.e. cyclosporine, tacrolimus and pimecrolimus), antioxidant and biologics (i.e alefacept, efalizumab, basiliximab, TNF-inhibitors -infliximab, rituximab) may be alternative approaches when OLP does not respond to the standard protocols.In this scenario, there are several studies on molecules different from glucocorticosteroids, but not sufficient or statistically adequate to justify their evidence-based use in OLP; large randomized placebo controlled trials are required to evaluate the safety and effectiveness of these non conventional therapies.In conclusion, since OLP is a chronic disease and requires long-term management, the dental/medical practitioner, who treats OLP patients, needs to know the natural history of OLP, how to monitor, and how to treat, taking in account all of the available modalities conventional and not, with pros and cons.

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Section: Introductionmentioning

confidence: 99%

Topical Therapies for Oral Lichen Planus Management and their Efficacy: A Narrative Review

Bagán

Compilato²,

Paderni³

et al. 2012

CPD

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“…This results in reduced expression of pro-inflammatory cytokines like IL-2 and IFN-γ, decreased activation of T lymphocytes and suppression of B cell functions [8]. It was approved as an immunosuppressant for use in liver, kidney and heart transplant recipients by the Food and Drug Administration.…”

Section: Introductionmentioning

confidence: 99%

“…It was approved as an immunosuppressant for use in liver, kidney and heart transplant recipients by the Food and Drug Administration. Due to the mechanistic similarity between cyclosporine and tacrolimus, FK506 has been administered to patients with inflammatory skin disorders such as psoriasis, pyoderma gangrenosum and Behçet’s disease with beneficial effects [8]. Although topical tacrolimus has been reported to be beneficial for individual lesions of superficial pemphigus (pemphigus foliaceus) and mucosal lesions of PV [9], oral tacrolimus has not yet been described as therapy for PV.…”

Section: Introductionmentioning

confidence: 99%

Recalcitrant Pemphigus Vulgaris Responding to Systemic Tacrolimus

et al. 2010

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Pemphigus vulgaris (PV) is an auto-immune blistering skin disease characterized by flaccid blisters and painful erosions of mucous membranes and skin. Suprabasal blister formation results from a loss of epidermal cohesion induced by auto-antibodies against the desmosomal protein desmoglein 3. Treatment of PV currently consists of systemic glucocorticosteroids and adjuvant immunosuppressive drugs such as azathioprine, mycophenolate mofetil, cyclophosphamide or dapsone. Due to the low incidence of PV, there are insufficient data to conclude which treatment is the most effective and safest. Thus far, systemic tacrolimus (FK506, Prograf®) has not yet been reported as adjuvant medication for PV. Here, we describe the successful use of systemic tacrolimus in 2 patients with recalcitrant PV of the oral mucosa. Tacrolimus was well tolerated, and clinical improvement allowed tapering of corticosteroids. Thus, oral tacrolimus may be a therapeutic alternative for patients with recalcitrant PV.

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“…CsA is a calcineurin inhibiting immunomodulatory drug (123), and it has been shown to inhibit histamine release probably by interfering with intracellular signaling following cross-linking of IgE receptor.…”

Section: Cyclosporinementioning

confidence: 99%

“…Cyclosporine and tacrolimus are calcineurin inhibiting immunosuppressant agents useful in the treatment of immune-mediated inflammatory dermatoses (123). Tacrolimus is a macrolide immunosuppressant drug isolated from Streptomyces tsukubaensis and is widely used in organ transplantation (131).…”

Section: Tacrolimusmentioning

confidence: 99%

Treatment of Chronic Urticaria

Tončić

Lipozenčić²,

Marinović³

2009

Urticaria and Angioedema, Second Edition

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Summary Urticaria is a disorder characterized by rapid onset of localized swelling of the skin or mucosa, called wheals or urtica. According to frequency and duration, urticaria can be divided into acute and chronic type. Chronic urticaria is any type of urticaria occurring every day or twice per week, lasting longer than 6 weeks. Chronic urticaria is a common disorder and estimated prevalence is 1% of the population. Also, it is not rare in childhood. The pathogenesis of chronic urticaria has not yet been completely understood. Chronic urticaria is a heterogeneous group of disorders, and according to the etiology and cause, several groups of chronic urticaria are distinguished, i.e. autoimmune, pseudoallergic, infection-related, physical urticaria, vasculitis urticaria and idiopathic urticaria. Treatment and management of chronic urticaria can be non-pharmacological and pharmacological, and sometimes it is not possible to control the disease with antihistamines only, which are considered to be the mainstay of treatment. In severe cases of chronic urticaria, especially if autoimmunity has been proven, several authors describe different modules of immunomodulation: cyclosporine, cyclophosphamide, mycophenolate-mofetil, omalizumab, plasmapheresis, systemic corticosteroids, and immunoglobulin therapy. This article primarily addresses the treatment of chronic idiopathic and autoimmune urticaria.

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Systemic ciclosporin and tacrolimus in dermatology

Cited by 75 publications

References 84 publications

Topical Therapies for Oral Lichen Planus Management and their Efficacy: A Narrative Review

Topical Therapies for Oral Lichen Planus Management and their Efficacy: A Narrative Review

Recalcitrant Pemphigus Vulgaris Responding to Systemic Tacrolimus

Treatment of Chronic Urticaria

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