Cyclosporine A (CYA) belongs to calcineurin inhibitor family, which has the ability to selectively suppress T cells. Owing to its immune-modulatory effects, it had been in use for graft vs host diseases and organ transplant rejection for many years, but in dermatology, it was first approved for use in 1997 in the treatment of psoriasis. Other off-label indications for skin diseases include atopic dermatitis, chronic spontaneous urticaria, lichen planus, pyoderma gangrenosum, alopecia areata, granuloma annulare, and several others. A thorough search of Medline-PubMed database, Google Scholar, and Uptodate was performed for evidence-based and peer-reviewed information. We have summarized the use of cyclosporine in dermatological diseases with respect to its, dosage, safety considerations, and monitoring guidelines. Furthermore, brief overview of its pharmacology, drug interactions, use in pregnancy, and lactation has been discussed. Despite of its common adverse effects like nephrotoxicity and hypertension, cyclosporine offers good safety profile when used in skin diseases. Decision to start cyclosporine therapy is individualized and it should be based on analysis of risk vs benefit. Nevertheless, CYA is preferred over other immunosuppressants in dermatology because of early therapeutic response and less myelosupression. This article offers concise but detailed summary of this beneficial immune-suppressive agent in skin diseases. K E Y W O R D S cyclosporine, dermatology, practical use 1 | INTRODUCTION Cyclosporine A (CYA) is a lipophilic cyclic polypeptide produced by fungal species (Tolypocladium inflatum), which was initially identified as antifungal agent but later found to have immense immunosuppressive properties. It inhibits T-cell activation by selectively inhibiting calcineurin phosphatase, thus suppressing production of IL-2. It has been in clinical practice for more than 30 years. It was initially employed primarily for the treatment of graft vs host diseases and organ transplant rejection but in 1997 U.S. Food and Drug Administration (FDA) approved its use in dermatology for the treatment of psoriasis. 1 Other off-label indications for skin diseases include atopic dermatitis, chronic spontaneous urticaria (CSU), lichen planus (LP), pyoderma gangrenosum (PG), alopecia areata (AA), and granuloma annulare. We used various search engines to get updated information, namely, Medline-PubMed database, Google Scholar, and Uptodate for evidence-based and peer-reviewed publications till April 2020. Systematic reviews, randomized controlled trials, and observational studies were screened and short-listed for critical evaluation of evidence. 2 | PHARMACOLOGY CYA binds with cytoplasmic proteins known as cyclophilins and this complex competitively binds and inhibits calcineurin. This leads to reduction in transcription of interleukin (IL)-2, tumor necrosis factor alpha (TNF-α), IL-3 and IL-4, interferon gamma, and granulocyte-Authors declare that the contents of this article are their own original and unpublished work.
OBJECTIVE: To compare the effects of coconut oil pulling on chemo-radiotherapy induced oral mucositis in head and neck cancer patients with Magic mouthwash. METHODOLOGY: This was a double-blind, randomized controlled trial, total of n=80 patients of chemo-radiotherapy induced oral mucositis of head and neck cancer were randomized into two arms A and B. A= Oil pulling using pure coconut oil and B= commercially prepared Magic Mouthwash. Each arm consisted of n=40 patients evaluated for a total duration of nine weeks using the WHO scale of oral mucositis and four different pain scores including Verbal pain intensity scale, Numeric pain intensity scale, Visual analog scale and FACES scale. Patients were evaluated at baseline 0, week 3, 6 and 9.Data was analyzed by using SPSS version 20. RESULTS: Total of n=72 participants completed the study between December 2017 to August 2018; randomly assigned to Group A (n=36) and group B (n=36).Of these n=48 were male and n=24 female. In both groups there was a reduction in WHO oral mucositis scores over the time of nine weeks; however, the differences were not statistically significant (p=0.633). The two treatments did not differ on the main outcome measure i.e. WHO mucositis scale from baseline, or on any other measure of pain, while followed for the nine weeks of trial period. Adverse effects were similar between the two arms and the most frequently reported side effects were radiation induced rash, mouth fatigue and dry mouth. CONCLUSION: Oil pulling and magic mouthwash was similar in reducing both the severity of oral mucositis and relieving the pain of chemo radiation induced oral mucositis in head and neck cancer patients. Oil pulling with coconut oil can be used as an alternative therapy to magic mouthwash for treating chemoradiation induced oral mucositis.
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