Poor efficacy of oral tacrolimus in the treatment of severe generalized atopic eczema in adults: A small retrospective case series

Abstract

We report a small, but novel case series of four adults with severe generalized atopic eczema (AE) not responsive to several other immunomodulatory therapies, who were treated with oral tacrolimus (5 mg twice-daily). Three of the four patients failed therapy with systemic tacrolimus, despite two of these showing an initial clinical response; the fourth patient remains on tacrolimus monotherapy with good control of skin disease. Although oral tacrolimus was well-tolerated in this small group of adults, the clinical efficacy in this series for severe AE was poor. Tacrolimus may yet have a role in less severe disease, but larger prospective studies are required to qualify its place as a treatment option in AE.

European S2k Guideline on Chronic Pruritus

“…Besides case reports (374), one open-label study on a sequential treatment with oral (6 weeks) and topical tacrolimus (11 weeks) in 12 patients with severe AD resulted in a substantial reduction in pruritus (375). In contrast to these results, a case series in 4 patients with AD treated with 5 mg tacrolimus twice daily for 14 months showed poor results in 3 of the patients (376). Expert recommendation: We suggest cyclosporine, methotrexate and azathioprine for refractory CP associated with inflammatory dermatoses and CPG.…”

Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative

“…Side effects included nausea, vomiting and diarrhoea, and elevated serum creatinine in one patient. Other reports of its use in atopic dermatitis are limited to small case series …”

“…Other reports of its use in atopic dermatitis are limited to small case series. 54,55 Intravenous immunoglobulin (IVIG) and intramuscular immunoglobulin Intravenous immunoglobulin, a plasma product pooled from up to 20 000 donors, has been assessed in a randomised placebo-controlled study in 40 children with moderate-to-severe atopic dermatitis; significant improvement was noted after 3 doses of IVIG (2 g/kg/month). 56 In another study of 10 children refractory to systemic immunosuppression, monthly treatment for 2 years was associated with significant symptomatic improvement, fewer infection-related exacerbations, a decrease in IgE, and being able to stop immunosuppressants in five cases.…”

Oral Tacrolimus Treatment of Pruritus in Prurigo Nodularis

“…Two studies have earlier been reported (1, 2) of oral tacrolimus treatment in atopic dermatitis. A case series of 4 patients using 5 mg twice-daily for up to 14 months showed poor effect in 3 of the patients (2). An openlabel study with 12 patients used, first, oral tacrolimus for 3 weeks, subsequently both oral and topical tacrolimus for 3 weeks, and finally topical tacrolimus alone for 8 weeks (1).…”

“…Tacrolimus is widely used topically to treat skin diseases, particularly atopic dermatitis. A few studies have explored the use of oral tacrolimus in inflammatory skin diseases, such as atopic dermatitis and psoriasis (1)(2)(3).…”