title: Sustained clinical effectiveness and favorable safety profile of topical sirolimus for tuberous sclerosis - associated facial angiofibroma.
abstract: BACKGROUND
  Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder characterized by the development of multisystem hamartomatous tumours. Facial angiofibroma appears in up to 80% of patients and has a considerable psychological impact. Various invasive procedures have been used, although they show limited effectiveness and potential adverse effects.
  
  
  OBJECTIVE
  To evaluate the sustained clinical benefits and safety profile of topical sirolimus applied to treat facial angiofibromas.
  
  
  METHODS
  This study was a non-blinded, uncontrolled case-series comprising 10 patients with TSC-associated facial angiofibroma that was treated with 0.4% sirolimus ointment 3 times a week for 9 months. Patients were clinically evaluated at baseline and at 6, 12, 24 and 36 weeks. Plasma levels of sirolimus were determined.
  
  
  RESULTS
  A sustained improvement was observed in erythema and in the size and extension of the lesions as early as the first weeks of treatment. Sirolimus plasma levels remained below detection limits (0.3 ng/mL) in all cases. The formula was well-tolerated with no local or systemic adverse effects.
  
  
  CONCLUSIONS
  Topical sirolimus seems to be an effective and safe medical alternative to surgery or laser-based treatments in patients with TSC-associated facial angiofibromas.
authors.affiliation: Departments of Dermatology and              Pharmacy, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Salido
authors.forename: G
authors.initials: G
authors.lastname: Garnacho-Saucedo
authors.forename: I
authors.initials: I
authors.lastname: Cuevas-Asencio
authors.forename: J
authors.initials: J
authors.lastname: Ruano
authors.forename: M
authors.initials: M
authors.lastname: Galán-Gutierrez
authors.forename: A
authors.initials: A
authors.lastname: Vélez
authors.forename: J C
authors.initials: JC
authors.lastname: Moreno-Giménez
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000209:etiology*; D002648:Child; D005145:Face; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use*; D014402:Tuberous Sclerosis / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus