ABSTRACT
Objective To assess which of topical tacrolimus and topical highly potent steroids,is more effective and safer in the treatment of pediatric vitiligo.Methods The PubMed,Cochrane library,Scopus and CINAHL plus databases were retrieved.The search was confined to English language articles.The randomized controlled trial(RCT) articles were included in our study.The quality of the identified articles was examined by using the CASP Randomised Controlled Trials Checklist.Results As a result,there were only a few studies related to the comparison.However,there were only two RCTs regarding a comparison of topical tacrolimus 0.1％ and clobetasol propionate 0.05 ％ in childhood vitiligo.Conclusion When the body surface area (BSA) involved in the child is ＜20 ％,and the disease is not rapidly spreading,topical therapy is the first choice.Topical tacrolimus may be considered as an alternative therapy for childhood vitiligo,especially for acrofacial and segmental types,before considering other modalities,but still need to observe long-term side effects.
ABSTRACT
Granuloma faciale (GF) is a chronic inflammatory disease of unknown origin characterized by nodular or granulomatous lesions on the face in adults. It is now regarded as a variant of vasculitis in which eosinophils are particularly numerous. It remains a benign, though chronic condition, not associated with systemic lesions like other forms of vasculitis. We report a case of 24-year-old male who presented with multiple erythematous nodules on photoexposed areas since past 2 years. The patient had been previously treated for Hansen’s disease for 3 months but with no relief. The patient responded wonderfully to intralesional triamcinolone and topical tacrolimus after two initial failed attempts with intralesional cryotherapy.
ABSTRACT
No abstract available.
Subject(s)
Eosinophilia , Eosinophils , Folliculitis , Skin Diseases, Vesiculobullous , TacrolimusABSTRACT
PURPOSE: Topical calcineurin inhibitor is recently developed topical immunomodulator, and preliminary studies showed its effectiveness in the treatment of atopic dermatitis (AD). However, some side effects including transient irritation can influence the patient compliance. So, there are some needs to improve the patient compliance. The purpose of this study was to evaluate the efficacy, safety and patient compliance with using topical tacrolimus 0.1% to treat AD when the correct information about topical tacrolimus are properly given to patients. METHODS: We examined the medical recordings, clinical severity scoring of total 194 AD patients at 9 general hospitals in Seoul, Korea from September 2010 to August 2011. We offered an infosheet of topical tacrolimus 0.1% and the patients applied it twice a day for 2 weeks. And we measured the efficacy of the topical tacrolimus 0.1% with SCORing atopic dermatitis (SCORAD) index, patient's global assessment (PGA), and investigator's global assessment (IGA). RESULTS: Topical tacrolimus 0.1% effectively controlled AD with a reduction of the SCORAD index from baseline 31.9 to 20.2 at 2 weeks of application. In IGA results showed 98% got improvement and in PGA, results showed 96% got improvement after treatment. Although 42.3% of the patients complained of adverse effects, these were all transient. The effect of information on topical tacrolimus 0.1% showed 34% patients could predict the side effect, 35% patients could feel safety to use, and 18% patients experienced side effect but could maintain topical calcineurin inhibitor. CONCLUSION: Topical tacrolimus 0.1% may be an effective treatment modality for AD when patients show good compliance for applying the ointment. And properly given, the correct information may increase the patient compliance.
Subject(s)
Humans , Calcineurin , Compliance , Dermatitis, Atopic , Hospitals, General , Immunoglobulin A , Korea , Medical Records , Patient Compliance , Prostaglandins A , TacrolimusABSTRACT
Frontal fibrosing alopecia (FFA) is a rare subtype of cicatricial alopecia. It was first described in 1994 by Kossard as postmenopausal frontal fibrosing alopecia. Patients who suffer from FFA show typical frontal hairline recession, and most patients experience eyebrow loss. It usually affects mainly post-menopausal women but the hormonal change due to menopause is unclear. Etiology of FFA is not clear, but it is assumed that certain autoantigens in the frontal and eyebrow hair follicles play a key role in its pathogenesis. There is no optimal treatment thus far. However, recently, topical calcineurin inhibitor was shown to be effective in early stage FFA via follicular targeted T-cell inhibition. Here, we report a case of a premenopausal 50-year-old female patient suffering from FFA displaying typical clinical features and minimal fibrosis around follicles by histological examination, which were improved by treatment with short-term systemic steroid and long-term topical calcineurin inhibitor.
Subject(s)
Female , Humans , Middle Aged , Alopecia , Autoantigens , Calcineurin , Eyebrows , Fibrosis , Hair Follicle , Menopause , Stress, Psychological , T-LymphocytesABSTRACT
Plasma cell cheilitis, an idiopathic benign inflammatory disorder of the lip, is characterized by dense plasma cell infiltration in the upper dermis. It usually presents as circumscribed erosive patches or plaques on the lower lip of an elderly person. The cause of plasma cell cheilitis is unknown, and the treatment is often disappointing. Tacrolimus is one of the newer immunomodulators which inhibit T-cell activation and inflammatory cytokine release. It is approved for the treatment of atopic dermatitis, and several reports have found topical tacrolimus to also be effective and well tolerated in other skin disorders, including other types of eczema, papulosquamous disorders, vesiculobullous diseases, vitiligo and connective tissue diseases. Herein, we report 3 cases of plasma cell cheilitis treated by topical tacrolimus ointment.
ABSTRACT
Granuloma faciale is an uncommon disease of an unknown origin, and it is characterized by single or multiple erythematous facial skin lesions. Histologically, a narrow Grenz zone of normal dermis is observed between the epidermis and the dense dermal polymorphous infiltrates. The course of granuloma faciale is chronic and the response to therapy is usually poor. We report here a case of granuloma faciale in a 37-year-old male who presented with a 13-year history of a solitary, red-brown, soft, elevated, irregular shaped plaque on the chin. The biopsy specimen showed a Grenz zone and a dense, dermal infiltrate of mononuclear cells mixed with numerous eosinophils and neutrophils that displayed a diffuse and perivascular pattern. After 4 courses of intralesional steroid injection, the lesion almost became flattened, although it remained a pinkish patch. The lesion almost cleared up after 4 months of applying 0.03% topical tacrolimus.
Subject(s)
Adult , Humans , Male , Biopsy , Chin , Dermis , Eosinophils , Epidermis , Granuloma , Injections, Intralesional , Neutrophils , Skin , TacrolimusABSTRACT
A dermatomiosite juvenil (DMJ) é uma doença inflamatória crônica idiopática que afeta principalmente músculos e pele. As lesões cutâneas podem persistir apesar do controle bem-sucedido da miosite. O tacrolimus tópico é um novo agente imunossupressor que tem sido usado no tratamento da dermatite atópica, com poucos relatos de seu uso em miopatias inflamatórias na faixa etária pediátrica. Foram descritos três pacientes com DMJ (dois meninos) com idade atual de 5,7 a 10,6 anos. A terapia inicial administrada para esses pacientes foi: corticosteróide (sistêmico em três e tópico em um), antimalárico em três e metotrexato em dois. Todos apresentavam lesões cutâneas refratárias (eritema malar, eritema difuso e/ou vasculite cutânea) após melhora significativa da fraqueza muscular. Tacrolimus tópico 0,03 por cento foi usado duas vezes ao dia após falha do tratamento prévio. As características das lesões foram avaliadas de acordo com a extensão e a gravidade no início do uso do fármaco e após oito e 16 semanas. Na segunda avaliação (oito semanas), notavelmente um paciente apresentou melhora completa do eritema malar e do eritema difuso em membros e tronco, e dois tiveram melhora parcial do eritema malar e da vasculite cutânea. Na terceira avaliação (16 semanas), dois pacientes tiveram resolução completa das lesões e um apresentava eritema malar persistente e eritema moderado em glúteos e região lombar. No último paciente, a melhora das lesões cutâneas foi alcan-çada apenas após o uso de ciclosporina por 16 semanas. Nenhum deles teve efeitos adversos. Tacrolimus tópico pode ser considerado em pacientes com DMJ e manifestações cutâneas refratárias. Estudos posteriores controlados e randomizados com esse fármaco devem ser realizados nessa doença inflamatória.
Juvenile dermatomyositis (JDM) is a rare idiopathic chronic inflammatory disease that affects mainly muscle and skin. Cutaneous lesions may persist despite successful treatment of myositis. Of note, topical tacrolimus is a new immunosuppressive agent that has been used to treat atopic dermatitis with few reports in pediatric inflammatory myopathies. Three JDM patients (two males) were described, current age from 5.7 to 10.6 years. The initial therapy administered for these patients were: corticosteroid (oral in three and topical in one), antimalarial in three and methotrexate in two. All of them had refractory skin lesions (malar rash, extensive rash and/or cutaneous vasculitis) after significant improvement of muscle weakness. Topical tacrolimus 0.03 percent was used twice daily after failure of previous treatment. The features of lesions were evaluated according to extension and severity at start of drug and after 8 and 16 weeks. At the second evaluation (8 weeks), remarkably one patient had complete improvement of malar rash and extensive rash in limbs and trunk, and two had partial improvement of malar rash and cutaneous vasculitis. At the third evaluation (16 weeks), two patients had complete resolution of lesions and one had persistent malar rash and moderate lumbar and gluteus rash. In the last patient, the improvement of skin lesions was reached only after 16 weeks of cyclosporine use. None of them had adverse effects. Topical tacrolimus could be considered in JDM patients with refractory cutaneous manifestations. Further randomized controlled trials with this agent should be performed in this inflammatory disease.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Dermatomyositis , Dermatomyositis/therapy , Erythema , Immunosuppressive Agents , Tacrolimus , VasculitisABSTRACT
BACKGROUND: Topical tacrolimus is widely used for the treatment of inflammatory skin diseases like atopic dermatitis, but there are few studies about the effect of topical tacrolimus for allergic contact dermatitis. Allergic contact dermatitis develops in two phases, the clinically silent sensitization phase, and the clinically apparent elicitation phase. OBJECTIVE: The purpose of this study is to investigate whether topical tacrolimus has an effect on both phases of murine contact hypersensitivity and dermatitis of repeated applications induced by diphenylcyclopropenone (DPCP). METHODS: Hairless mice were treated with topical tacrolimus before and after DPCP challenging. The suppressive effect of topical tacrolimus was measured by skin erythema, ear swelling, weight change and cell numbers of local lymph nodes. In addition, a biopsy was carried out and epidermal hyperplasia was investigated microscopically. TNF-alpha mRNA on the mice which were treated with topical tacrolimus to one side of the ears was measured before and after being chronically challenged with DPCP on both ears. RESULTS: Topical tacrolimus pretreatment dramatically supressed inflammatory reactions in the sensitization phase, and treatment of topical tacrolimus after sensitization dramatically supressed inflammatory reactions in the elicitation phase. Topical tacrolimus also dramatically supressed inflammatory reactions in the repeated DPCP-induced dermatitis. CONCLUSION: The data revealed topical tacrolimus could effectively suppress murine contact hypersensitivity and dermatitis of repeated applications induced by DPCP. Putting these results together, topical tacrolimus can be very effective in not only the treatment but also the prevention of allergic contact dermatitis. Larger studies are needed to determine the clinical relevance.
Subject(s)
Animals , Mice , Biopsy , Cell Count , Dermatitis , Dermatitis, Allergic Contact , Dermatitis, Atopic , Dermatitis, Contact , Ear , Erythema , Hyperplasia , Lymph Nodes , Mice, Hairless , RNA, Messenger , Skin , Skin Diseases , Tacrolimus , Tumor Necrosis Factor-alphaABSTRACT
Chronic actinic dermatitis is an idiopathic photodermatoses presenting as severe persistent eczematous skin eruptions on sun-exposed skin, with an enormous itching sensation. The treatment includes photoprotective measurements, topical or systemic corticosteroids and other immunosuppressive agents. However, occasionally, the condition is resistant to these therapies and results in a significant disabling of the involved individuals. We tried 0.03% topical tacrolimus ointment on a chronic actinic dermatitis patient who had previously been treated with conventional steroid therapy with no improvement. Two weeks after application of the topical tacrolimus ointment, the itching sensation was significantly improved and in 4 weeks, the skin lesions began to improved with no other side effects.
Subject(s)
Humans , Adrenal Cortex Hormones , Immunosuppressive Agents , Photosensitivity Disorders , Pruritus , Sensation , Skin , TacrolimusABSTRACT
Oral lichen planus (OLP) is a painful chronic inflammatory condition, that is often resistant to many therapeutic approaches, including immunosuppressive agents. Topical tacrolimus has recently been recognized as a safe and effective remedy in the treatment of OLP. We, rerein, describe 3 patients with oral lichen planus, who showed a substantial improvement after the use of topical tacrolimus ointment (0.1%). This topical agent was well tolerated in all 3 patients and could be used an effective medicine in controlling oral lesions of lichen planus.
Subject(s)
Humans , Immunosuppressive Agents , Lichen Planus , Lichen Planus, Oral , TacrolimusABSTRACT
Vitiligo is a common skin depigmentation disorder and treatment options are generally unsatisfactory and difficult. We report a case of vitiligo resistant to classic treatment showing remarkable repigmentation with topical tacrolimus ointment 0.03%.