Treatment of Chronic Discoid Lupus Erythematosus with Topical Tacrolimus

Carrillo, Daniel de la Rosa; Christensen, Ole

doi:10.1080/00015550310007698

Cited by 18 publications

(4 citation statements)

References 9 publications

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“…63 TCIs are considered first-or secondline agents for CLE 11,36,37,49 and may exhibit comparable efficacy to topical corticosteroids 62 with an improved side effect profile. 13,32,37,62,63 Case reports have documented the success of topical tacrolimus in promoting significant hair regrowth in 4 patients with recalcitrant alopecia secondary to DLE, both as monotherapy (using 0.1% ointment) 64 and as an adjunct to oral antimalarial (using compounded 0.3% lotion). 13…”

Section: Topical Therapies Topical Calcineurin Inhibitors (Tcis)mentioning

confidence: 99%

Recent Insight on the Management of Lupus Erythematosus Alopecia

Desai¹,

Miteva²

2021

CCID

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Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.

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Section: Topical Therapies Topical Calcineurin Inhibitors (Tcis)mentioning

confidence: 99%

Recent Insight on the Management of Lupus Erythematosus Alopecia

Desai¹,

Miteva²

2021

CCID

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“…De la Rosa Carrillo and Christensen65 reported a female patient with long-standing DLE of her face and scalp who was treated with tacrolimus 0.1% ointment. Interestingly, apart from clearing of facial lesions, regrowth of terminal hair on most of the scalp was observed.…”

Section: Treatmentmentioning

confidence: 99%

Update on the use of topical calcineurin inhibitors in cutaneous lupus erythematosus

Sticherling¹

2011

BTT

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Cutaneous manifestations of lupus erythematosus (CLE) are manifold, presenting with unspecific skin manifestations or well-defined clinical dermatological entities. Their relation to each other as well as to systemic lupus erythematosus is variable, yet diagnostically and therapeutically challenging. Therapeutic decisions have to be based on the activity and distribution as well as the type of skin lesions and the extent of systemic disease. Limited skin manifestations may be amply tackled by topical therapy, so far, mainly relying on corticosteroids. In many cases, however, internal treatment has to be combined by using antimalarials, in addition to strict UV-protection. The advent of topical calcineurin inhibitors has contributed substantially to the armamentarium of external treatment options. By specifically interfering with intracytoplasmic signal transduction to activate the nuclear factor of activated T-cells (NF-AT), they are able to modulate various inflammatory mechanisms. The two available compounds, pimecrolimus and tacrolimus, do not induce the skin atrophy characteristic of corticosteroids. They have been studied in a number of case reports, but only in a few randomized, comparative studies. Both are well-tolerated, but differentially effective in the various subsets of CLE. Further studies are needed to directly compare the two compounds to each other, as well as to topical corticosteroids, before final recommendations can be made.

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“…No difference in outcome was demonstrated between the treatment groups 73 . Tacrolimus 0·1% ointment applied twice daily has been used with variable success 74–78 . Walker et al.…”

Section: Lymphocytic Groupmentioning

confidence: 99%

Management of primary cicatricial alopecias: options for treatment

et al. 2008

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Primary cicatricial alopecias (PCAs) are a poorly understood group of disorders that result in permanent hair loss. Clinically, they are characterized not only by permanent loss of hair shafts but also of visible follicular ostia along with other visible changes in skin surface morphology, while their histopathological hallmark usually (although not always) is the replacement of follicular structures with scar-like fibrous tissue. As hair follicle neogenesis in adult human scalp skin is not yet a readily available treatment option for patients with cicatricial alopecias, the aim of treatment, currently, remains to reduce symptoms and to slow or stop PCA progression, namely the scarring process. Early treatment is the key to minimizing the extent of permanent alopecia. However, inconsistent terminology, poorly defined clinical end-points and a lack of good quality clinical trials have long made management of these conditions very challenging. As one important step towards improving the management of this under-investigated and under-serviced group of dermatoses, the current review presents evidence-based guidance for treatment, with identification of the strength of evidence, and a brief overview of clinical features of each condition. Wherever only insufficient evidence-based advice on PCA management can be given at present, this is indicated so as to highlight important gaps in our clinical knowledge that call for concerted efforts to close these in the near future.

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Treatment of Chronic Discoid Lupus Erythematosus with Topical Tacrolimus

Cited by 18 publications

References 9 publications

Recent Insight on the Management of Lupus Erythematosus Alopecia

Recent Insight on the Management of Lupus Erythematosus Alopecia

Update on the use of topical calcineurin inhibitors in cutaneous lupus erythematosus

Management of primary cicatricial alopecias: options for treatment

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