Oral Cyclosporin Plus Topical Corticosteroid Therapy Diminishes Bone Mass in Children with Eczema

Abstract

Topical corticosteroids remain the most common treatment for eczema; however, it is uncertain whether long-term use of these agents has any adverse effect on bone mass. Cyclosporin is very useful in patients with severe atopic dermatitis who have failed conventional therapy. It has been shown to induce bone loss. We compared 43 children with severe eczema who were using topical corticosteroids with 73 healthy children. Of the 43 patients, six were also taking cyclosporin. Bone mineral density was measured in the lumbar spine and in the femoral neck using dual-energy X-ray absorptiometry. In multivariate analysis, subjects with eczema had lower lumbar spine bone mineral density (-0.03 g/cm(2); p = 0.015) and bone mineral apparent density (-0.01 g/cm(3); p = 0.008) but higher FN BMAD (+0.02 g/cm(3); p = 0.029) compared with controls. Patients with eczema on topical corticosteroids who had used cyclosporin had lower lumbar spine bone mineral apparent density (-0.01; p = 0.006) compared with those only on topical corticosteroids in both adjusted and unadjusted analysis. In conclusion, children with severe eczema have decreased lumbar spine bone mass, which is primarily mediated by cyclosporin use rather than by topical corticosteroid use. This effect is likely to lead to a modest increase in the risk of wrist and forearm fractures in children using this agent.

Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference

“…86 Cyclosporine has been used for children with dermatologic disorders, such as atopic dermatitis, psoriasis, Henoch-Schönlein purpura, and polymyositis-dermatomyositis, at doses from 3 to 10 mg/kg/d. 84,[87][88][89] The spectrum of side effects is similar to that seen in adults. Recently, it was reported that patients with eczema on topical corticosteroids and cyclosporine had lower lumbar spine bone mineral apparent densities compared with those on only topical corticosteroids.…”

“…The authors suggest that this may lead to a modest increase in the risk of wrist and forearm fractures in children using cyclosporine. 89 …”

“…Rheumatologic and dermatologic use of cyclosporine in children[84][85][86][87][88][89][90]117 Henoch-Schö nlein purpura Two children (age 4 and 5 y) successfully treated with CSA (3-5 mg/kg/d) for 2 mo Atopic dermatitis Studies in [80 children (aged 2-16 y) showed improvement with CSA (2.5-5 mg/kg/d) PsoriasisReports of successful treatment with CSA (1-3.5 mg/kg/d) in 7 children (age 0.8-11 y); 2.5-5.0 mg/kg/d not effective in 4 severe resistant cases (10 mg/kg/d, given accidentally, effective in one case); 3 children with generalized pustular psoriasis cleared at doses from 1-2 mg/kg/d Juvenile idiopathic arthritis Steroid-sparing effect at 3.0-10 mg/kg/d; adverse events common but mild and reversible Polymyositis/dermatomyositis Improved control and steroid-sparing at 3.5-10 mg/kg/d in 3 refractory children (age 6-15 y) CSA, Cyclosporine.…”

Assessment of dietary food and nutrient intake and bone density in children with eczema

“…33 In childhood eczema, patients with severe disease treated with topical corticosteroids and cyclosporin had much lower BMD as measured by dual energy X-ray absorptiometry (DEXA) than those prescribed topical corticosteroids alone. 34 The BMD was similar between Dutch children with moderate-to-severe eczema and the general population. 35 Overall, there are limited data regarding BMD in childhood eczema.…”

Bone mineral density in children with moderate to severe atopic dermatitis

“…Pedreira et al 8 also found a decreased BMD in children with moderate to severe AD, associated with the use of cyclosporine (n = 6). Comparison with our data is difficult because children using inhalation or oral corticosteroids at inclusion were excluded and data on the use of these drugs in the past were not given in the study of Pedreira et al 8 Furthermore, the authors did not express BMD in Z-scores. A limitation in our study is that the number of children using additional systemic treatment is low.…”