Tacrolimus in dermatology.
BACKGROUND
Tacrolimus (FK 506), a metabolite of the fungus Streptomyces tsukubaensis, is an anti-T-cell drug. It acts by inhibiting the production of IL-2, IL-3, IL-4, TNFa, and GM-CSF. More potent and with slightly less secondary effects than cyclosporine, it has been the object of considerable interest, especially in conditions that could benefit from the latter.


OBJECTIVE
In psoriasis, a placebo-controlled double-blind study has shown oral tacrolimus at 0.1 mg/kg/day to be effective in controlling recalcitrant lesions. In human, small studies have reported tacrolimus ointment to be effective in controlling acute contact dermatitis. Short-term trials of topical tacrolimus in the treatment of atopic dermatitis have recently shown excellent results in both adults and children. In animal studies of hair growth disorders, topical tacrolimus induces anagen and protects from chemotherapy-induced alopecia. Animal studies with the ointment for the prevention of skin graft rejection, lupus dermatoses, and skin papilloma formation have also shown to be promising.


CONCLUSIONS
There are case reports of pyoderma gangrenosum, Sezary's syndrome, and Behcet's disease successfully treated with oral tacrolimus but, because of their small number, they remain anecdotal at this point.
Dé Tran
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Centre Hospitalier de l'Université de Montréal (CHUM), Campus Notre-Dame, 1560 Sherbrooke East, Montreal, Quebec, Canada H2L 4M1.
Guay
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Chartier
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Tousignant
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D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000818:Animals; D001528:Behcet Syndrome / Q000188:drug therapy; D002648:Child; D002986:Clinical Trials as Topic; D006224:Cricetinae; D003876:Dermatitis, Atopic / Q000188:drug therapy; D003877:Dermatitis, Contact / Q000188:drug therapy; D004311:Double-Blind Method; D006197:Hair / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy; D051379:Mice; D010919:Placebos; D011565:Psoriasis / Q000188:drug therapy; D017511:Pyoderma Gangrenosum / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D012751:Sezary Syndrome / Q000188:drug therapy; D012871:Skin Diseases / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000188:drug therapy; D016038:Skin Transplantation; D016559:Tacrolimus / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors
D007166:Immunosuppressive Agents; D010919:Placebos; D016559:Tacrolimus