Safe and Effective Treatment of Refractory Facial Lesions in Atopic Dermatitis Using Topical Tacrolimus following Corticosteroid Discontinuation

Abstract

Background: Topical corticosteroids are commonly applied in atopic dermatitis (AD) treatment. However, their chronic use may be associated with significant side effects at the application site. Skin atrophy and other undesirable effects are frequently seen after long-term corticosteroid treatment. In addition, when application of corticosteroids is discontinued, a rebound phenomenon in the facial lesions can occur within several days. Topical tacrolimus, an immunosuppressant currently used to prevent rejection after solid-organ transplantation, presents a potential alternative therapeutic agent for AD. Objective: The present study is the first trial designed to evaluate the efficacy and safety of topically applied tacrolimus ointment after corticosteroid discontinuation without a washout phase in severe, long-term facial AD. Patients/Methods: Forty-seven patients with facial refractory AD were recruited, of whom 38 had undergone topical corticosteroid treatment for at least 4 weeks before enrollment (group 1) and the other 9 had not received steroid treatment (group 2). All 47 patients received 0.1% tacrolimus ointment, and the severity index and pruritus score were assessed as an AD clinical activity index every week and compared with baseline data. Results: Both the severity index and pruritus score improved significantly in group 1 after 1 and 2 weeks of application (p < 0.01, respectively). Group 2 showed the greatest improvement at 4 weeks (p < 0.05). In this trial, none of the patients experienced a rebound phenomenon associated with tacrolimus treatment. A transient sensation of burning at the application site was the only adverse event in 31 of the 47 (66%) enrolled patients, but this condition improved after several days. Spectrophotometric assessment of the facial lesion following treatment revealed significant improvement in group 1 (p < 0.05). Conclusion: The present results indicate that topical tacrolimus treatment following corticosteroid discontinuation is safe and effective in refractory facial AD.

Comparison of the Effects of Daily Applications between Topical Corticosteroid and Tacrolimus Ointments on Normal Skin: Evaluation with Noninvasive Methods

“…It is also favorable for the treatment of the facial skin because its penetration decreases with the improvement of the inflammatory skin lesions, in contrast to corticosteroid which can penetrate even into normal facial skin [16]. Kawakami et al [8]reported that topical tacrolimus treatment was safe and effective in refractory facial AD following corticosteroid discontinuation. On the other hand, one has to be alert to bacterial and viral infections such as herpesvirus on the skin treated with tacrolimus because it is an immunosuppressive agent that interferes with cell-mediated immunity [17].…”

“…In addition to epidermal and dermal atrophy, barrier dysfunction of the stratum corneum (SC) also occurs. Recently, topical tacrolimus ointment has been introduced as an effective treatment for the facial lesions of AD [6, 7, 8]. However, information about its short-term as well as long-term effects on normal human skin is still limited.…”

Topical Tacrolimus as a Therapeutic Adjunct in Patients with Cutaneous Lupus erythematosus

“…in atopic dermatitis, abrupt discontinuation of the prolonged use of topical corticostreoids can result in exacerbation within several days. Recently, topical tacrolimus has been shown to be safe and effective in refractory facial lesions of atopic dermatitis following corticosteroid discontinuation [3]. Here we describe the efficacy of topical tacrolimus as an adjunct in 3 patients with various cutaneous manifestations of LE in the face.…”

Inhibitory Activity of CX-659S, a Novel Diaminouracil Derivative, against the Rebound Phenomenon following Withdrawal of Corticosteroid Therapy for Chronic Contact Hypersensitivity Responses

“…However, relapse often occurs after discontinuation of prolonged use of topical corticosteroids [3, 4]. This relapse, defined as exacerbated AD sometimes associated with facial swelling, is referred to as a rebound phenomenon [3, 5]. The mechanism underlying the rebound phenomenon has remained unclear, and though some clinical studies have evaluated this phenomenon, there are only a few reports focusing on it.…”