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Dermatitides
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Allison Perz, Tara Jennings, Robert Duffy, Warren Heymann
Management: AD is a chronic disorder that is prone to flares, particularly with environmental triggers. Management includes both medication and lifestyle changes. Topical corticosteroids applied twice daily as needed are the mainstay of treatment, such as topical hydrocortisone 2.5%, topical fluticasone 0.05%, or more potent steroids, such as topical clobetasol 0.05%. Tacrolimus ointment, pimecrolimus cream, or topical crisaborole can be used on the face and intertriginous areas.
Pimecrolimus
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Pimecrolimus is a derivative of the macrolactam ascomycin with immunosuppressant and immunomodulating properties. Its mechanism of action involves calcineurin inhibition, blockage of T-cell activation, blocking signal transduction pathways in T-cells, reducing the ability of mast cells to release chemicals that promote inflammation, and inhibition of the synthesis of inflammatory cytokines, specifically Th1- and Th2-type cytokines. Pimecrolimus is indicated for topical treatment of mild to moderate atopic dermatitis (1).
Topical Calcineurin Inhibitors
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
Pimecrolimus, like tacrolimus, has also been used in combination therapies. In a randomized controlled study, pimecrolimus combined with narrowband UVB therapy showed significantly better improvement in facial vitiligo lesions compared to narrowband UVB alone. However, the repigmentation rate of other body parts was not different in the two groups [31]. In another study, microdermabrasion was combined with 1% pimecrolimus cream in the treatment of nonsegmental vitiligo in children. Of lesions treated with the combination, 60.4% showed a positive clinical response and 43.4% of lesions showed complete repigmentation. In patients treated with pimecrolimus alone, 32.1% of lesions showed repigmentation, whereas only 1.7% of lesions responded in the placebo group [32]. The better efficacy of this combination in the treatment of vitiligo may be due to modulation of immune response and autoinoculation of melanocytes as well as improved absorption of pimecrolimus through the erosions and inflammation of skin caused by microdermabrasion.
Safety and efficacy of Pimecrolimus in atopic dermatitis among Chinese infants: a sub-group analysis of a five-year open-label study
Published in Journal of Dermatological Treatment, 2023
Xia Dou, Lingling Liu, Xuejun Zhu, Weijing Wen, Chunya Ni, Yi Zhao, Zhixin He, Hongchun Li, Qiuning Sun, Qinping Yang, Xinfen Sun, Yifeng Guo
Atopic dermatitis (AD) primarily affects infants and young children. Unique mutations in the filaggrin (FLG) gene have been identified in Asian populations associated with AD, most notably c.3321delA, whereas R501X and 2282del4 mutations are commonly found in European population (25). This may lead to the production of higher IL-17 cells in Asian population. Although TCSs are often prescribed, non-corticosteroid treatments are needed because compliance with TCSs is poor due to concerns about their side effects. The PETITE study, which was a pivotal study of Pimecrolimus in pediatric patients with atopic dermatitis (11), used a unique real-world design in which TCSs were used according to their label. The caregivers of infants randomized to treatment with PIM had ready access to short-term TCSs as rescue medication if AD flares could not be controlled with PIM.
Vehicles for atopic dermatitis therapies: more than just a placebo
Published in Journal of Dermatological Treatment, 2022
Simon G. Danby, Zoe D. Draelos, Linda F. Stein Gold, Amy Cha, Bonnie Vlahos, Laraine Aikman, Paul Sanders, Dan Wu-Linhares, Michael J. Cork
The proactive use of topical pharmaceutical treatments at reduced application frequencies over long periods of time has been shown to reduce the risk of flares and improve the long-term control of AD (100). As mentioned above, emollients display significant potential as flare reduction therapies in their own right (48). This suggests that the vehicle effect may be stronger in flare prevention studies conducted over longer periods of time. In a study by Siegfried et al., significantly more participants receiving proactive treatment with pimecrolimus cream were flare free at 6 months (52%) compared with those receiving vehicle (34%) (101). Similar findings have been reported in other studies (94,102,103), suggesting a 1.5× lower risk of flares in the interventional group compared with the vehicle group overall. Although there is a clear distinction between the vehicle plus active drug and the vehicle alone in each case, the difference in effects is notably smaller than reported in trials of short-term reactive treatment. In the study by Kapp et al., the response to treatment was monitored at 3 weeks, 6 months, and 12 months (94). Although pimecrolimus 1% cream displayed significantly greater efficacy compared with the vehicle at 3 weeks in this study, the difference in effects was lost after 12 months due to an enhanced response to the vehicle with time. Studies by Wiren et al. (75) and Weber et al. (74) demonstrate that emollient treatment alone can significantly reduce the risk of flares, highlighting the potential for strong vehicle effects in this type of study.
Treatments for inverse psoriasis: a systematic review
Published in Journal of Dermatological Treatment, 2020
Kelly A. Reynolds, Deeti J. Pithadia, Erica B. Lee, Jashin J. Wu
Two randomized, double-blind RCTs evaluated the efficacy of pimecrolimus 1% cream in the treatment of 48 patients with moderate to severe inverse psoriasis (13,22). Gribetz et al. found that 71% of patients (20 of 28) treated with pimecrolimus cream achieved an Investigator-Global Assessment (IGA) score of 0 (‘clear’) or 1 (‘almost clear’) after 8 weeks of treatment, compared to 21% in the vehicle cream group (6 of 29; p < .001) (13). Kreuter et al. assessed patients’ M-PASI scores after 4 weeks of either 1% pimecrolimus (n = 20), 0.005% calcipotriol (n = 20), 0.1% betamethasone (n = 20), or vehicle cream (n = 20). In the pimecrolimus group, M-PASI scores were significantly decreased from 19.2 at baseline to 11.5 after 4 weeks (p = .001); however, average improvements in PASI scores in the pimecrolimus group (39.7%) were not significantly better than improvements observed in the vehicle cream group (21.1%) nor the calcipotriol group (62.4%). M-PASI scores increased during the 6-week follow-up period for all three treatment arms, but the increase was least pronounced in the pimecrolimus group (22). Of all 48 patients treated with pimecrolimus, five patients reported transient itching and burning upon application, and one reported application-site paresthesia (13,22).