Topical Calcineurin Inhibitors
Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan in 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.
Treatments for Sensitive Skin
Golara Honari, Rosa M. Andersen, Howard Maibach in Sensitive Skin Syndrome, 2017
For many years, pimecrolimus 1% cream has been approved as an effective, noncorticosteroid, anti-inflammatory treatment for atopic dermatitis (AD) (33,34); now, it has been proven effective in patients with sensitive skin and its underlying mechanism. In 32 patients with sensitive skin, the severity of pruritus and burning sensations was significantly decreased after using topical 1% pimecrolimus cream. A positive capsaicin-like response was seen in 63% of patients and 19% of patients showed a positive camphor-like response on application sites. A negative capsaicin-like response and/or negative camphor-like response were present in 18.8% of the patients. Authors concluded that pimecrolimus may rapidly inhibit or alleviate the itch or burning sensation of patients with sensitive skin. Also, the therapeutic effect of pimecrolimus seems to be relevant to the mechanisms that activate or sensitize TRPV1 and desensitizes TRPV1 in the skin sensory afferents (35). However, this treatment option is only on prescription and for patients suffering from severe symptoms.
Topical Therapies for Psoriasis
Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi in Psoriasis and Psoriatic Arthritis, 2017
The topical macrolide calcineurin inhibitors pimecrolimus and tacrolimus are currently licensed for atopic eczema only [83–86]. By inhibiting the intracellular processing of calcineurin, the production of IL2, IL4, and interferon gamma by T lymphocytes is inhibited, resulting in a clinically relevant reduction of inflammatory processes. A number of case compilations and controlled studies have demonstrated good clinical effects and tolerability in plaque psoriasis [87–91], as well as in inverse locations of psoriasis, especially the face and folds [91–97]. In a double-blind, vehicle-controlled study on inverse psoriasis, twice daily application of 1% pimecrolimus resulted in a fast and significant improvement by patient and examiner evaluation [98]. At other sites, reasonable effectiveness could only be achieved under occlusion, which on the other side may increase the risk of skin irritation inherent to these compounds. However, initial burning sensations and pruritus may subside under continuous treatment. Despite a black box warning for the potential risk of lymphoma upon prolonged use of topical calcineurin inhibitors, the available long-term data do not support this possible adverse event [84,86,99]. Altogether, topical calcineurin inhibitors may represent an alternative to corticosteroids at sensitive sites and in sensitive populations like children (see below).
A practical algorithm for topical treatment of atopic dermatitis in the Middle East emphasizing the importance of sensitive skin areas
Published in Journal of Dermatological Treatment, 2019
Ashraf M. Reda, Ayman Elgendi, Ahmed Ismail Ebraheem, Mohammed S. Aldraibi, Mohammed Saleh Qari, Magdy Mohammad R. Abdulghani, Thomas Luger
In the current algorithm, TCS are reserved for the short-term treatment of severe disease flares; TCS of class 2 or 3 potency are recommended (71). A low to medium potency TCS should be used to treat severe disease flares on the face and other sensitive areas, whereas a higher potency TCS can be used on other body locations (71). The clinical benefits of TCS for the treatment of AD have been extensively investigated in over 110 randomized controlled trials (27,85). They effectively and rapidly control disease flares through their anti-inflammatory, anti-proliferative and immunosuppressive actions (2,5). The results of a real-life study in which 2034 patients used pimecrolimus at the first signs or symptoms of eczema and in which severe flares were treated with TCS showed that after 3 months, 59.0% of patients were clear or almost clear of disease (70). Although potent, TCS can effectively resolve severe AD flares however, their use should be restricted to short-term intervention, due to their potential for multiple local and systemic side effects (71).
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).
A systematic review of evidence based treatments for lichen simplex chronicus
Published in Journal of Dermatological Treatment, 2021
Michelle C. Juarez, Shawn G. Kwatra
Topical pimecrolimus 1% applied twice daily for three months resulted in significant decrease in pruritus and disease severity in 24 patients across two prospective observational studies. In one study with 12 female patients with moderate to severe vulvar LSC treated with 1% pimecrolimus, 75% of patients reported complete resolution of pruritus by week 4 of treatment with sustained resolution until the end of treatment at 12 weeks (12). Additionally, disease severity scores as measured by the Investigators Global Assessment (IGA) decreased from a moderate-to-severe baseline score to no disease by the end of treatment with concomitant improvements in erythema, excoriation, and lichenification for all patients. Kelekci et al reported similar results with significant decreases in pruritus by 4 and 12 weeks of treatment compared to baseline (pruritus score 3.75 at baseline, 2.17 at 4 weeks p < .01, 0.42 at 12 weeks p < .001) and complete cure of disease in 83% of treated patients (13). In another study, 0.1% topical tacrolimus significantly decreased mean itch scores, itch frequency, and overall affected surface area after treatment (p < .001 for all) in 40 patients with scrotal LSC (14).
Related Knowledge Centers
- Atopic Dermatitis
- Immunosuppressive Drug
- Immunotherapy
- Inflammation
- Lichen Planus
- Psoriasis
- Skin Condition
- Seborrhoeic Dermatitis
- Lupus Erythematosus
- Vitiligo