The Safety and Efficacy of Tacrolimus Therapy in Patients Younger Than 2 Years With Atopic Dermatitis

Patel, Rishi; Straten, Melody R. Vander; Korman, Neil J.

doi:10.1001/archderm.139.9.1184

Cited by 52 publications

(32 citation statements)

References 6 publications

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“…Avoidance of application over atypical pigmented lesions is recommended [45]. Absorption through intact skin is felt to be very limited in patients with vitiligo and is limited even in pediatric atopic dermatitis where the skin barrier is impaired [46][47][48]. Twice-daily application is required for optimal results [49].…”

Section: Topical Calcineurin Inhibitorsmentioning

confidence: 99%

Current Management of Pediatric Vitiligo

Driessche

Silverberg²

2015

Pediatr Drugs

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Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4-2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child's age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0-3 years), [2] ages 4-8 years, [3] ages 9-12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5-6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.

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Section: Topical Calcineurin Inhibitorsmentioning

confidence: 99%

Current Management of Pediatric Vitiligo

Driessche

Silverberg²

2015

Pediatr Drugs

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“…However, clinical and histological features are essentially eczematous changes suggesting that the AR is a T-cell-mediated type 4 hypersensitivity response against UV-radiation-damaged DNA or similar molecules which may improve during long-term tacrolimus therapy. Tacrolimus can be used in specific indications under strict dermatological control for adults and juvenile patients older than 2 years [12, 13]. A recently published consensus statement emphasized that based on current knowledge there should be no enhanced risk for the development of skin cancer or cutaneous lymphomas under treatment with topical calcineurin inhibitors [14].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Nodular Actinic Reticuloid with Tacrolimus Ointment

Gröne

Kunz²,

Zimmermann³

et al. 2006

Dermatology

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Actinic reticuloid (AR) is the severest clinical variant of chronic actinic dermatitis (CAD) and describes a persistent photoinduced skin disorder often associated with delayed-type hypersensitivity reactions. Histopathologically, AR resembles pseudolymphoma and may also show features of cutaneous lymphoma. In contrast to other UV-induced skin diseases, AR patients show persistent photosensitivity to UV radiation and visible light parallel to permanent changes of skin texture with infiltrated papules and thickened plaques. Therapeutically, CAD is a problematic condition. Daily application of sun protection has to be combined with local or systemic immunosuppression. However, various therapeutic approaches including systemic corticosteroids and other systemic immunosuppressive agents are limited by severe side effects. Tacrolimus, a Streptomyces-derived immunosuppressive macrolide antibiotic and inhibitor of calcineurin, has been proven successful in vari ous inflammatory skin diseases including atopic eczema, allergic contact dermatitis and photodermatoses without undesired side effects. We present a case of severe recalcitrant and nodular chronic actinic dermatitis responding to topically applied tacrolimus (Protopic^®). To avoid further relapses we continued this therapy twice a day over a period of 2 years.

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“…26 However, pharmacokinetic data obtained from clinical trials in children aged <2 years did not suggest concentrations high enough to cause systemic immunosuppression, unlike oral administration, or demonstrate a correlation between systemic concentrations and percentage body surface area treated or the duration of treatment. 27 Likewise, there was no interference with the development of normal immune responses to vaccinations. 28 Besides demonstrating extreme efficacy, these trials demonstrate safety data for IT use in atopic eczema, but more extensive surveillance is needed to determine long-term safety.…”

Section: ---4mentioning

confidence: 99%