Effects of 1-year intermittent treatment with topical tacrolimus monotherapy on skin collagen synthesis in patients with atopic dermatitis

Kyllönen, H; Remitz, Anita; Mandelin, Johanna; Elg, Peter; Reitamo, Sakari

doi:10.1111/j.1365-2133.2004.06017.x

Cited by 79 publications

(54 citation statements)

References 42 publications

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“…Topical applications of tacrolimus ointment result in minimal systemic absorption, do not cause a decrease in collagen synthesis or skin thickness, and have not been associated with limiting adverse events thus far. [16][17][18][19][20][21] Tacrolimus ointment (0.03% and 0.1%) has been clinically shown to reduce the extent, severity, and symptoms of moderate to severe AD in children as young as 2 years of age and to be safe and effective for long-term use for up to 4 years. [22][23][24][25][26][27] However, it has not been evaluated for treatment of mild to moderate cases.…”

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confidence: 99%

Tacrolimus Ointment 0.03% Is Safe and Effective for the Treatment of Mild to Moderate Atopic Dermatitis in Pediatric Patients: Results From a Randomized, Double-Blind, Vehicle-Controlled Study

Schachner

Lamerson²,

Sheehan³

et al. 2005

Pediatrics

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ABSTRACT. Objective. This study was designed to compare the safety and efficacy of tacrolimus ointment 0.03% with vehicle ointment for the treatment of mild to moderate atopic dermatitis (AD) in pediatric patients.Methods. A total of 317 patients (2-15 years of age) with mild to moderate AD were randomized to receive tacrolimus ointment or vehicle ointment twice daily in a 6-week, multicenter, double-blind study. Efficacy evaluations, including the Investigators' Global Atopic Dermatitis Assessment, eczema area and severity index, percentage of total body surface area affected, and patient assessment of itch occurred at baseline, day 4, and weeks 2, 4, and 6. Cutaneous adverse events were recorded to evaluate safety.Results. At the end of study, 50.6% (80 of 158) of the patients were treated successfully with tacrolimus ointment based on Investigators' Global Atopic Dermatitis Assessment scores, a significant improvement compared with patients treated with vehicle ointment (25.8% [41 of 159]). The percent improvement from baseline in eczema area and severity index scores was also significantly greater in tacrolimus-treated patients (54.8%) compared with vehicle-treated patients (20.8%). There was also a significant improvement in the percentage of total body surface area affected of tacrolimus-treated patients (50.5% reduction from baseline) compared with vehicletreated patients (16.4%). Patient itch scores were significantly lower in tacrolimus-treated patients (2.1) versus vehicle-treated patients (3.7). Overall, the incidence of cutaneous adverse events reported was similar for both treatment groups. There was no significant difference in the incidence of burning or stinging between treatment groups. Significantly fewer tacrolimus-treated patients prematurely discontinued from the study because of a cutaneous adverse event in the treatment area or experienced increased itching and erythema at the application site.Conclusion A topic dermatitis (AD) is a recurrent inflammatory skin disease, with intense pruritus as its hallmark symptom, and often follows a chronic, relapsing course. 1 It frequently affects children, with symptoms developing in 65% of patients before 1 year of age and in 90% by 5 years of age. 2 Although many children will outgrow the condition by 10 years of age, 60% remain symptomatic as adults. 2 If not outgrown in childhood, the condition progresses to adulthood, with recurrent flares that may be severe and sometimes debilitating. The prevalence of AD in the United States is projected to be between 7% and 17% of school-aged children and has increased greatly over the past 40 years. 3 Several quality-of-life issues have been reported in children with AD, including sleep disturbances, changes in activity, irritability, and self-consciousness. 4-8 AD exacts a marked toll on the children and their families through both direct and indirect financial expenses of medical care. Even more significant are the stressful impacts of sleep deprivation, missed school and work, and the time spent on the dai...

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confidence: 99%

Tacrolimus Ointment 0.03% Is Safe and Effective for the Treatment of Mild to Moderate Atopic Dermatitis in Pediatric Patients: Results From a Randomized, Double-Blind, Vehicle-Controlled Study

Schachner

Lamerson²,

Sheehan³

et al. 2005

Pediatrics

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“…86,91,92 Although their costs relative to topical corticosteroids may raise economic concerns for use as long-term treatment, an analysis utilizing a Markov model to calculate cost-effectiveness ratios indicates that annual costs of TCIs are in line with other total direct costs for AD. 94,95 Furthermore, because systemic absorption of TCIs is low, the occurrences of adverse events (nephrotoxicity, hypertension, neurotoxicity, and cancer) associated with systemic calcineurin inhibitors is unlikely.…”

Section: Toward a Treatment Algorithmmentioning

confidence: 99%

“…10,[85][86][87][88][89][90][91][92][93] This paradigm permits treatment to progress from a chosen induction therapy to maintenance therapy. The clinician should bear in mind that TCI and lowest effective potency topical corticosteroid treatments (both monotherapy and in combination) can be sustained safely for a full 12-week course.…”

Section: Toward a Treatment Algorithmmentioning

confidence: 99%

A clinician's paradigm in the treatment of atopic dermatitis

Abramovits

2005

Journal of the American Academy of Dermatology

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“…Apart from corticosteroids, topical tacrolimus does not cause either skin atrophy or telangiectasia even by long-term use, which is the major advantage of this drug. One of the possible explanation is that tacrolimus does not affect endothelial cells, keratinocytes and fibroblasts, and thus does not affect collagen synthesis [1,2] and skin thickness [3]. In this review, I have made a focus on a therapeutic option of topical tacrolimus for psoriasis.…”

Section: Introductionmentioning

confidence: 99%

Topical Tacrolimus for Psoriasis

Yamamoto¹

2009

TOALLJ

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Tacrolimus ointment is an agent approved for the treatment of atopic dermatitis; however, tacrolimus has been expected also as one of the promising therapeutic strategies for other T-cell mediated inflammatory skin disorders. Recent progress have demonstrated that topical tacrolimus shows beneficial effects for psoriasis depending on sites. In particular, facial, intertriginous, and genital psoriasis respond to topical tacrolimus dramatically in a short period. Further, topical tacrolimus is tolerable also for child psoriasis. Because topical tacrolimus does not induce either skin atrophy or telangiectasia different from corticosteroids, it is recommended to be a first choice. The most proper way of topical tacrolimus therapy at present is to use this ointment intermittently after the remission was once obtained, paying attention to its adverse effects.

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Effects of 1-year intermittent treatment with topical tacrolimus monotherapy on skin collagen synthesis in patients with atopic dermatitis

Abstract: Long-term tacrolimus ointment therapy in patients with AD is nonatrophogenic and reverses corticosteroid-induced skin atrophy.

Cited by 79 publications

References 42 publications

Tacrolimus Ointment 0.03% Is Safe and Effective for the Treatment of Mild to Moderate Atopic Dermatitis in Pediatric Patients: Results From a Randomized, Double-Blind, Vehicle-Controlled Study

Tacrolimus Ointment 0.03% Is Safe and Effective for the Treatment of Mild to Moderate Atopic Dermatitis in Pediatric Patients: Results From a Randomized, Double-Blind, Vehicle-Controlled Study

A clinician's paradigm in the treatment of atopic dermatitis

Topical Tacrolimus for Psoriasis

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