News Forum: The use of topical calcineurin inhibitors for skin diseases

Wollina U. Am J Clin Dermatol 2007;8(3):157-73

When the topical calcineurin inhibitors pimecrolimus and tacrolimus were launched, their steroid-free composition was a welcome alternative for atopic dermatitis. They remain licensed for this condition and are widely used. This article looks at other skin diseases where they may also prove useful.

In seborrhoeic dermatitis, asteatotic eczema and contact dermatitis, they have been shown to be of great benefit, competing directly with topical steroids. In psoriasis, they have also been shown to be useful, especially in facial and intertriginous regions.

For cutaneous lupus, initial studies have been promising, but with rosacea and rosacea-like eruption, the response has been mixed. In lichen planus and lichen sclerosus, there has been a good clinical response. In vitiligo, a degree of repigmentation has been reported, with the most promising results being in facial and neck areas and in children. This effect is improved with the concomitant use of UVB radiation. As well as these, the author describes a long list of case reports and series regarding other skin conditions where benefit has been implied. These are areas where further investigation is warranted.

Although the main effect of the topical calcineurin inhibitors is via T-cell control, it may be that they have other modes of action. The effect they have in pruritis and erythema, for example, cannot be explained by their effect on T-cells and further investigation of these effects is required.

Any use for conditions beyond atopic dermatitis would be outside current licences, but as with steroids when they were first developed, this family continues to seem a promising therapeutic group in dermatology.

- Dr Nigel Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

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