Mycophenolate mofetil as a treatment for urticarial dermatitis

Abstract

We report two cases of adults with urticarial dermatitis who could not be managed by a variety of treatments but who obtained good control with mycophenolate mofetil (MMF). A clinical response was seen 6-8 weeks from treatment onset and they were maintained on MMF 1 g twice daily (case 1), and MMF 1 g omni mane and 500 mg omni nocte (case 2), with no major exacerbations for many years. MMF is an immunosuppressive agent, which is currently used off-label for many dermatological conditions. To date, there have been no studies investigating the use of MMF as a treatment for urticarial dermatitis. The cases we present suggest that MMF is an effective treatment for this condition, and we recommend that MMF be considered as a treatment option.

Urticarial Dermatitis: Clinical Characteristics of Itch and Therapeutic Response to Cyclosporine

“…Urticarial dermatitis has been known to represent a therapeutic challenge using conventional treatments such as systemic steroid or antihistamines9. As urticarial dermatitis involves cutaneous lesions reminiscent of both urticaria and eczema, we hypothesised that treatment with cyclosporine might be effective910.…”

“…As urticarial dermatitis involves cutaneous lesions reminiscent of both urticaria and eczema, we hypothesised that treatment with cyclosporine might be effective910. As the main target of cyclosporine is the helper T cells, we speculated that the depletion of lymphocytes and macrophages in epidermis and dermis, and inhibition of histamine release from the mast cells might have contributed to the improvement of symptoms in urticarial dermatitis111.…”

Consensus statement for the diagnosis and treatment of urticaria: A 2017 update

“…[ 89 ] A retrospective analysis of 19 patients with autoimmune and chronic idiopathic urticaria, 89% got control over urticaria symptoms within 14 weeks of MMF (1000 mg to 6000 mg daily in two divided doses) but frequently reported GI adverse effects. [ 90 ] Moreover, case study depicts MMF to be successful in treating urticarial dermatitis[ 91 ] and cyclosporine intolerant CU patients. [ 92 ] However, because of low evidence, doubtful effect, high cost, and incidence of adverse effects present guideline suggests against using of MMF in CSU/CINDU.…”