Review of the potential photo-cocarcinogenicity of topical calcineurin inhibitors: position statement of the European Dermatology Forum.
Topical Calcineurin Inhibitors (TCIs) used for the treatment of atopic eczema modify the immune regulatory function of the skin and may have the potential to enhance immunosuppressive ultraviolet (UV) effects. Current recommendations on UV protection in eczema patients treated with PCIs are inconsistent and have given rise to uncertainty and anxiety in patients. Therefore, the European Dermatology Forum (EDF) developed a position statement which reviews critically the available data with regard to the problem, especially analysing and commenting the limitations of rodent models for the human situation. There is no conclusive evidence from rodent trials to indicate that long-term application of TCIs is photococarcinogenic. There is a need for further studies to investigate the validity of mouse models as well as long-term cohort studies in patients using TCIs. Available data suggest that long-term application of TCIs is safe, that there is no evidence of increased skin cancer risk and that it is ethical to treat patients with TCIs when indicated.
Ring
J
J
Department of Dermatology and Allergy Biederstein, Technische Universität München, Bavaria, Germany. johannes.ring@lrz.tum.de
Barker
J
J
Behrendt
H
H
Braathen
L
L
Darsow
U
U
Dubertret
L
L
Giannetti
A
A
Hawk
J
J
Hönigsmann
H
H
Kemeny
L
L
Luger
T
T
Meurer
M
M
Murphy
G
G
Peserico
A
A
Ranki
A
A
Reunala
T
T
Saurat
J
J
Sterry
W
W
van de Kerkhof
P
P
D000287:Administration, Topical; D000818:Animals; D065095:Calcineurin Inhibitors; D003043:Cocarcinogenesis; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000276:immunology*; D004195:Disease Models, Animal; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000276:immunology*; D051379:Mice; D009381:Neoplasms, Radiation-Induced / Q000276:immunology*; D012878:Skin Neoplasms / Q000209:etiology* / Q000276:immunology*; D016559:Tacrolimus / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000276:immunology; D014466:Ultraviolet Rays / Q000009:adverse effects*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D016559:Tacrolimus