Effectiveness of topical calcineurin inhibitors as monotherapy or in combination with hydroxychloroquine in cutaneous lupus erythematosus

2011 ◽  
Vol 26 (6) ◽  
pp. 762-767 ◽  
Author(s):  
G. Avgerinou ◽  
D.-K. Papafragkaki ◽  
A. Nasiopoulou ◽  
A. Arapaki ◽  
A. Katsambas ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Calcineurin Inhibitors ◽  
Topical Calcineurin Inhibitors ◽  
Cutaneous Lupus

Treatment of cutaneous lupus erythematosus

Lupus ◽  
2010 ◽  
Vol 19 (9) ◽  
pp. 1125-1136 ◽  
Author(s):  
A. Kuhn ◽  
F. Ochsendorf ◽  
G. Bonsmann
Keyword(s):  
Lupus Erythematosus ◽  
Cutaneous Lupus Erythematosus ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Sun Exposure ◽  
Cutaneous Lesions ◽  
Pharmacological Agents ◽  
Resistant Disease ◽  
Topical Calcineurin Inhibitors ◽  
Cutaneous Lupus

In patients with cutaneous lupus erythematosus (CLE) and mild skin involvement, local therapy consisting of topically applied pharmacological agents, e.g., topical/intralesional steroids, may be sufficient. Recent reports have also shown efficacy of topical calcineurin inhibitors in patients with CLE, particularly on the face. Special attention receives consistent sun protection through photoresistant clothing and application of light-shielding substances with highly potent chemical or physical UVA- and UVB-protective filters. These substances should be applied in sufficient amount (ca. 2 mg/cm2) at least 20—30 minutes before sun exposure in order to avoid induction and exacerbation of cutaneous lesions. The mainstay of treatment for disfiguring and widespread skin manifestations in patients with CLE, irrespective of the subtype of the disease, is antimalarial agents. Our understanding of the use of combinations of antimalarials and proper dosing according to the ideal bodyweight limits problems with toxicity. Further therapies, such as methotrexate, or retinoids, dapsone, mycophenolate mofetil, and thalidomide in selected cases, can be helpful for patients with resistant disease; however, side effects need to be taken into consideration. Recent advances in biotechnology resulted in the development of novel systemic agents, but randomized controlled trials are necessary for the approval of new therapeutic strategies in CLE. Lupus (2010) 19, 1125—1136.

Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders

2019 ◽  
Vol 23 (4_suppl) ◽  
pp. 27S-34S ◽  
Author(s):  
Lyn Guenther ◽  
Charles Lynde ◽  
Yves Poulin
Keyword(s):  
Lupus Erythematosus ◽  
Therapeutic Option ◽  
Seborrheic Dermatitis ◽  
Cutaneous Lupus Erythematosus ◽  
Calcineurin Inhibitors ◽  
Lichen Sclerosus ◽  
Hand Dermatitis ◽  
Off Label ◽  
Topical Calcineurin Inhibitors ◽  
Quality Evidence

Off-label prescribing is a common practice in dermatology, particularly when uncommon dermatologic diseases have limited or no approved treatment options. Topical calcineurin inhibitors are approved for the treatment of eczema, and their anti-inflammatory, immunomodulatory, and steroid-sparing effects make them an attractive therapeutic option for a wide variety of other dermatologic diseases. This review summarizes and qualifies the available evidence supporting the clinical effectiveness of tacrolimus ointment and pimecrolimus cream in non-eczema indications. There is high-quality evidence supporting the effectiveness of topical calcineurin inhibitors in multiple dermatological disorders including vitiligo; psoriasis of the face, folds, and genitals; seborrheic dermatitis; chronic hand dermatitis; contact dermatitis; oral lichen planus; lichen sclerosus; morphea; and cutaneous lupus erythematosus. Lower-quality evidence suggests they may be considered as an option in many other cutaneous disorders.

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