Tacrolimus in dermatologic disorders.

OBJECTIVE: To review the data surrounding the use of tacrolimus for skin disorders. DATA SOURCES: Articles were obtained through a MEDLINE search of English-language literature (1990-May 2000); references of the retrieved publications were further reviewed for relevant literature. STUDY SELECTION: Orginal studies in humans regarding the use of tacrolimus for skin disorders were included. DATA EXTRACTION: The major outcomes extracted from the literature involved patient response to therapy and adverse effects. DATA SYNTHESIS: Tacrolimus offers an additional therapeutic approach to the treatment of immunologically based skin disorders. led trials and case reports indicates topical tacrolimus is a safe and effective alternative treatment in patients with atopic dermatitis. Case reports document efficacy in recalcitrant pyoderma gangrenosum, mucosal lichen planus, and ichthyosis linearis trolled trials and case reports indicate oral tacrolimus is effective in recalcitrant plaque psoriasis. Case reports document efficacy in recalcitrant pyoderma gangrenosum and leukocytclastic vascultis. The clinical utility of oral tacrolimus in skin disorders is limited due to potentially severe adverse effects such as infections, hypertension, hyperglcemia hyperkalemia, nephrotoxicity neurotoxicity, and increased risk of neoplasia. CONCLUSIONS: Most of the available data indicate short-term (3 wk to 3 mo) topical tacrolimus is a safe and effective treatment alternative for inflammatory skin disorders. Further study is needed to evaluate long-term safety and efficacy and to determine the best dosage regimen. Although oral tacrolimus has demonstrated efficacy in inflammatory skin disorders, the potenial for serious adverse effects limits its utility to third-line therapy for patients who are resistant to, or intolerant of, conventional therapies.

Drug-induced lichen planus.

Lichen planus is a relatively common skin disorder of unknown etiology. A wide variety of drugs have been implicated in its cause. Using five or more cases of drug-induced lichen planus reported in at least three separate reports with at least one case of probable cause by the scale of Naranjo et al as criteria, sufficient evidence exists that beta-blockers, methyldopa, penicillamine, quinidine, and quinine play a role in this disorder. Evidence is insufficient for angiotensin-converting enzyme inhibitors, sulfonylurea agents, carbamazepine, gold, lithium, and a host of miscellaneous drugs. Given available epidemiologic evidence, nonsteroidal antiinflammatory agents probably should also be considered causative. Differentiating drug-induced lichen planus from the idiopathic disorder is difficult; most evidence is based on the dechallenge and rechallenge with the drug when these data are available.