Topical tacrolimus in the treatment of perianal Crohnʼs disease

Abstract

These preliminary data suggest that topical tacrolimus is effective and safe in the treatment of perianal or anal ulcerating Crohn's disease. This therapy is unlikely to be beneficial in fistulizing perianal Crohn's disease, although a larger study is required to confirm this.

Efficacy of Rectal Tacrolimus for Induction Therapy in Patients With Resistant Ulcerative Proctitis

“…Work examining topical perianal tacrolimus therapy in adult CD patients also demonstrated clinical efficacy 23 , and although tacrolimus is absorbed well transdermally 24 , only low trough levels of tacrolimus were detected in the blood 23 . In these preliminary studies, the use of topical tacrolimus was associated with very few side effects.…”

Long‐term outcome of non‐fistulizing (ulcers, stricture) perianal Crohn’s disease in patients treated with infliximab

“…In two patients with perianal ulcers treated with thalidomide, one achieved clinical response and the other one showed initial improvement with reduction in ulcer size and drainage at 1 year, 10 Ciclosporin treatment healed 70% of perianal ulcers in 20 patients after a median follow-up of 7 months. 11 Regarding topical treatment, 10% metronidazole decreased the Perianal Crohn's Disease Activity Index and anorectal pain in 14 patients at 4 weeks, 12 whereas tacrolimus did not heal ulcers, but led to rapid improvement in terms of depth, surface area and pain in 4 patients after 3 months, 13,14 Local depot methylprednisolone injection also showed some efficacy in treating painful anal Crohn's disease in 5 patients with a follow-up of 12 months. 15 Two reports suggested a beneficial effect of hyperbaric oxygen in 8 patients.…”

Topical Tacrolimus for Psoriasis

“…Of interest, comedos in the genital areas complicated by lichen sclerosus were also improved [56]. Additionally, another report have shown that topical tacrolimus is effective for perianal ulcerating Crohn's disease [58]. These results suggest the site-specific effectiveness for topical tacroimus therapy.…”