Efficacy of Topical Calcineurin Inhibitors in Psoriasis

Abstract

Background: Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are indicated for the treatment of atopic dermatitis but ive also been studied in the treatment of psoriasis.Objective: To define the efficacy of topical calcineurin inhibitors in the treatment of psoriasis. Methods: We searched for English-language articles published since 1990 in PubMed. Ovid/Cochrane, and Embase using "tacrolimus," "pimecrolimus," or "topical calcineurin inhibitors" and "psoriasis."Results: Nine double-blind and 13 open studies demonstrated the efficacy of topical tacrolimus in psoriasis, especially for facial, genital, and intertrigious psoriasis, and four double-blind and one open study demonstrated the efficacy of topical pimecrolimus.Conclusions: The evidence (double-blind and open studies) is strong that topical tacrolimus and, to a lesser extent, pimecrolimus have efficacy in the treatment of psoriasis. Since these agents do not cause cutaneous atrophy, they likely have a special role in facial, genital, and intertriginous psoriasis. Further studies would help define their roles in psoriasis.Contexte: Les inhibiteurs de la calcineurine topiques (tacrolimus et pimecrolimus) sont indiqués dans le traitement de la dermatite atopique, mais ils ont aussi fait l'objet de recherches dans le traitement du psoriasis.Objectif: L'étude visait à déterminer l'efficacité des inhibiteurs de la calcineurine topiques dans le traitement du psoriasis. Méthode: Une recherche d'articles publiés en anglais, depuis 1990 a été effectuée dans les bases de données PubMed, Cochrane (OVID) et Embase, à l'aide des mots «tacrolimus», «pimecrolimus» ou «inhibiteurs de la calcineurine topiques» et «psoriasis».Résultats: Neuf essais à double insu et 13 essais non à l'insu ont démontré l'efficacité du tacrolimus topique dans le psoriasis, notamment le psoriasis facial, génital et intertrigineux, et quatre essais à double insu et un essai non à l'insu ont démontré l'efficacité du pimecrolimus topique.Conclusions: D'après les données recueillies (essais à double insu et essais non à l'insu), tout porte à croire que le tacrolimus et, dans une moindre mesure, le pimecrolimus topiques sont efficaces dans le traitement du psoriasis. Comme ces substances ne causent pas d'atrophie cutanée, elles pourraient sans doute jouer un rôle particulier dans le psoriasis facial, génital et intertrigineux. Il faudrait mener d'autres études afin de préciser leur rôle dans le psoriasis.

Clinical Characterisation at Onset of Childhood Psoriasis – A Cross Sectional Study in Sweden

“…Thus, presence of genital lesions may be the only manifestation, especially in pre-pubertal boys, and can strengthen the diagnosis of psoriasis in atypical cases. It is important to differentiate between fungal infection, eczema and psoriasis in these patients since fungal infection is treated differently and psoriasis often requires more potent topical glucocorticoids or tacrolimus to obtain effect (30)(31)(32).…”

Pediatric psoriasis: Evolving perspectives

“…Midstrength to ultrapotent TCS are often required for thicker plaques that occur on sites other than the facial, genital, or intertriginous areas because the psoriasiform hyperplasia limits the efficacy of lower‐strength products. Topical calcineurin inhibitors are often used as steroid‐sparing agents for psoriasis on the facial, genital, and intertriginous areas …”

Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

“…In these cases, addition of a topical steroid-sparing medication (e.g. , vitamin D analog [13], salicylic acid [14] or TCI [15]) may improve efficacy and increase the chances of remission.…”