Efficacy and safety of tacrolimus ointment in pediatric Patients with moderate to severe atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is an immunological skin disease. It is common in pediatric populations and often requires topical steroid treatment. Moderate to severe AD may not respond to topical steroids. They often require systemic steroids, which may result in growth retardation. Protopic, a non-steroid, tacrolimus based ointment which is a calcinurin inhibitor has been proved to be effective in caucacian with AD. OBJECTIVE: To evaluate safety and efficacy of 0.03% tacrolimus ointment (Protopic&) in moderate to severe AD in pediatric patients age 2-12 years. MATERIAL AND METHOD: This was a one month multicenter open-label clinical trial using tacrolimus ointment twice daily in 61 subjects with moderate to severe AD from September to December 2004. Efficacy assessments were measured by Physician's Global Evaluation of Clinical Response (PhGECR), Eczema area and Severity Index (EASI), Patient's Global Evaluation of Clinical Response (PaGECR), and Quality of Life (QOL). Safety assessment was measured by incidence rate of adverse events. RESULTS: Fifty-eight patients completed the studies. Twenty-two patients were male; thirty-nine patients were female. Twenty-nine patients had moderate AD. Thirty-two patients had severe AD. Three cases had discontinued treatment at the third week due to increase in severity. Over all PhGECR were significantly increased, 94% showed moderate improvement in PhGECR at week 4 or end of treatment (EOT)and 83% had better improvement in PaGECR at EOT Within 7 days, tacrolimus demonstrated rapid onset in reduction of EASI score and itch in patients. Mean QOL were significantly decreased at the end of the present study. Incidence of adverse events included application site burning (21%), itching (17%), pruritus (9%), infections(3%), and erythema and folliculitis (2%). Burning sensation, erythema, pruritus and itching were resolved after the first week. CONCLUSION: Topical tacrolimus ointment is effective and safe in moderate to severe AD. It significantly improved PhGECR, EASI, PaGECR, and QOL in pediatric patients after the first week of treatment and continued through the end of the study. The major adverse events were burning, itching, and pruritus, which were resolved within the first week of therapy.

Cutaneous granuloma in systemic lymphoma: a case report in Thailand.

A 68-year-old woman presented with multiple erythematous infiltrative nodules and plaques on her face, trunk and extremities, 7 months after having complete remission from chemotherapy treatment of non-Hodgkin's lymphoma. Biopsy from the skin lesion showed tuberculoid granuloma without lymphoma. Special stains and culture were negative for micro-organism. Immunohistochemistry revealed polymorphic T and B cells infiltration without evidence of malignancy. The skin lesions subsided completely after corticosteroid treatment. Two months later, she developed brain involvement of lymphoma that responded well to radiation and chemotherapy.

Food-dependent, exercise-induced anaphylaxis: first case report in Thailand.

A forty-year-old military personnel presented with generalized urticaria, syncope, shortness of breath and headache associated with jogging after ingestion of a taro-filled bun and a red bean-filled bun. Skin prick test was positive for bread, taro and wheat but negative for red bean and preservative. Exercise challenge tests were performed. Exercise alone failed to induce any allergic reaction but exercise following ingestion of a taro-filled bun and a red bean-filled bun induced generalized urticaria. Since the patients stopped taking these types of food, the urticaria has not returned. This is the first case report of food-dependent, exercise-induced anaphylaxis in Thailand.