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Balestri R, Rizzoli L, Pedrolli A, Urru SAM, Rech G, Neri I, Girardelli CR, Magnano M. Analysis of current data on the use of topical mTOR inhibitors in the treatment of facial angiofibromas in tuberous sclerosis complex-An update. J Eur Acad Dermatol Venereol 2023; 37:474-487. [PMID: 36300771 DOI: 10.1111/jdv.18693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome causing hamartomatous growths in multiple organs. Facial angiofibromas occur in up to 80% of patients and can be highly disfiguring. Treatment for these lesions is challenging. Recently, topical rapamycin has been proposed as an effective option to treat angiofibromas but a commercially available compound has not yet been developed in Europe. We conducted a retrospective review with the aim to update the current data on the use of topical rapamycin in the treatment of angiofibromas in TSC, focusing on the optimal concentration and trying to establish which vehicle should be preferred. Thirty-nine reports describing the use of topical rapamycin in the treatment of angiofibromas in TSC were considered, involving a total of 483 patients. An improvement of the lesions has been shown in over 90% of subjects, particularly if the treatment was started at early stages. Several different formulations (ointment, gel, solution and cream) with a wide range of concentrations (0.003%-1%) were proposed, of which a pharmacological analysis has also been performed. Topical rapamycin can be considered an effective and safe option for the treatment and the prevention of facial angiofibromas in younger patients, but the best formulation has yet to be established. Our review demonstrates that ointment and gel should be preferred, but it is not clear which concentration is optimal. However, according to this study, the 0.1% concentration represents the first choice. Long-term and comparative studies between topical rapamycin formulations are required in order to establish which treatment has a better outcome and lower recurrence rate.
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Affiliation(s)
- Riccardo Balestri
- Division of Dermatology, Outpatient Consultation for Rare Diseases, Trento, Italy
| | - Laura Rizzoli
- Division of Dermatology, Outpatient Consultation for Rare Diseases, Trento, Italy
| | - Annalisa Pedrolli
- Division of Pediatrics, Outpatient Consultation for Rare Diseases, Trento, Italy
| | - Silvana Anna Maria Urru
- Hospital Pharmacy Unit, Trento General Hospital, Autonomous Province of Trento, Trento, Italy
| | - Giulia Rech
- Division of Dermatology, Outpatient Consultation for Rare Diseases, Trento, Italy
| | - Iria Neri
- Dermatology Unit, IRCSS Policlinico di S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlo R Girardelli
- Division of Dermatology, Outpatient Consultation for Rare Diseases, Trento, Italy
| | - Michela Magnano
- Division of Dermatology, Outpatient Consultation for Rare Diseases, Trento, Italy
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Abarca Lachén E, Hernando Martínez P, Gilaberte Calzada Y. The Most Useful Pharmaceutical Formulations (Individualized Medications) in Pediatric Dermatology: A Review. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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3
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Abarca Lachén E, Hernando Martínez P, Gilaberte Calzada Y. The Most Useful Pharmaceutical Formulations (Individualized Medications) in Pediatric Dermatology: A Review. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:302-313. [PMID: 33220314 DOI: 10.1016/j.ad.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023] Open
Abstract
The administration of appropriate doses of active ingredients and excipients is crucial for achieving desired treatment outcomes in pediatric dermatology. A number of factors need to be considered, including the characteristics of the lesion, the patient, and the drug. An additional challenge in pediatric settings is the limited number of commercially available formulations suitable for use in children. Drug compounding, which is the preparation of medications tailored to the needs of individual patients, is a good alternative for pediatric populations for a number of reasons. Using a customized compound, the clinician can prescribe formulations that contain the optimal dose of the active ingredients within acceptable limits and the most suitable vehicle and formulation components. Compounding can also be used to combine several active ingredients in a single medication and even adapt the vehicle to the characteristics of the lesion and the needs of the patient. The pharmaceutical formulations described in this review are based on extensive clinical experience and can be customized to meet individual needs.
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Affiliation(s)
- E Abarca Lachén
- Facultad de Ciencias de la Salud, Universidad San Jorge, Villanueva de Gállego, Zaragoza, España; Sociedad Española del Medicamento Individualizado (LASEMI), España.
| | - P Hernando Martínez
- Facultad de Ciencias de la Salud, Universidad San Jorge, Villanueva de Gállego, Zaragoza, España; Sociedad Española del Medicamento Individualizado (LASEMI), España
| | - Y Gilaberte Calzada
- Servicio de Dermatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España
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Le Guyader G, Do B, Vieillard V, Andrieux K, Paul M. Comparison of the In Vitro and Ex Vivo Permeation of Existing Topical Formulations Used in the Treatment of Facial Angiofibroma and Characterization of the Variations Observed. Pharmaceutics 2020; 12:pharmaceutics12111060. [PMID: 33171735 PMCID: PMC7694993 DOI: 10.3390/pharmaceutics12111060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022] Open
Abstract
Rapamycin has been used topically to treat facial angiofibromas associated with tuberous sclerosis for more than a decade. In the absence of a commercial form, a large number of formulations have been clinically tested. However, given the great heterogeneity of these studies, particularly with regard to the response criteria, it was difficult to know the impact and thus to compare the relevance of the formulations used. The objective of this work was therefore to evaluate the link between the diffusion of rapamycin and the physico-chemical characteristics of these different formulations on Strat-M® membranes as well as on human skin using Franz cells. Our results underline the importance of the type of vehicle used (hydrogel > cream > lipophilic ointment), the soluble state of rapamycin and its concentration close to saturation to ensure maximum thermodynamic activity. Thus, this is the first time that a comparative study of the different rapamycin formulations identified in the literature for the management of facial angiofibromas has been carried out using a pharmaceutical and biopharmaceutical approach. It highlights the important parameters to be considered in the development and optimization of topical rapamycin formulations with regard to cutaneous absorption for clinical efficacy.
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Affiliation(s)
- Guillaume Le Guyader
- Department of Pharmacy, AP-HP, Hôpital Henri Mondor, F-94010 Créteil, France; (B.D.); (V.V.); (M.P.)
- Department of Pharmacy, CHI Creteil, F-94010 Créteil, France
- Correspondence: ; Tel.: +33-1498-147-53
| | - Bernard Do
- Department of Pharmacy, AP-HP, Hôpital Henri Mondor, F-94010 Créteil, France; (B.D.); (V.V.); (M.P.)
- Department of Pharmacy, Université Paris-Saclay, Matériaux et Santé, 92296 Châtenay-Malabry, France
| | - Victoire Vieillard
- Department of Pharmacy, AP-HP, Hôpital Henri Mondor, F-94010 Créteil, France; (B.D.); (V.V.); (M.P.)
| | - Karine Andrieux
- Department of Pharmacy, Université de Paris, CNRS, INSERM, UTCBS, F-75006 Paris, France;
| | - Muriel Paul
- Department of Pharmacy, AP-HP, Hôpital Henri Mondor, F-94010 Créteil, France; (B.D.); (V.V.); (M.P.)
- Department of Pharmacy, EpidermE, Université Paris Est Créteil, F-94010 Créteil, France
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Topical use of mammalian target of rapamycin inhibitors in dermatology: A systematic review with meta-analysis. J Am Acad Dermatol 2019; 80:735-742. [DOI: 10.1016/j.jaad.2018.10.070] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 01/05/2023]
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Portocarrero LKL, Quental KN, Samorano LP, de Oliveira ZNP, Rivitti-Machado MCDM. Tuberous sclerosis complex: review based on new diagnostic criteria. An Bras Dermatol 2018; 93:323-331. [PMID: 29924239 PMCID: PMC6001077 DOI: 10.1590/abd1806-4841.20186972] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023] Open
Abstract
Tuberous sclerosis complex is a multisystemic, autosomal dominant genetic disorder with complete penetrance, that can evolve with hamartomas in multiple organs, such as skin, central nervous system, kidney and lung. Due to the wide phenotypic variability, the disease is often not recognized. Tuberous sclerosis complex affects one in 10,000 newborns and most patients are diagnosed during the first 15 months of life. The diagnostic criteria for tuberous sclerosis were reviewed in 2012, at the second International Tuberous Sclerosis Complex Consensus Conference. The diagnosis is based on genetic criteria, by the identification of inactivating pathogenic mutation of tumor suppressor genes TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary, cardiac and neurological manifestations. The treatment of tuberous sclerosis complex consists, mainly, in management of the symptoms caused by hamartomas and in prevention of organ failure. Multidisciplinary approach is recommended, in order to obtain better clinical outcomes.
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Affiliation(s)
- Larissa Karine Leite Portocarrero
- Outpatient Clinic of Pediatric Dermatology, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP),
São Paulo (SP), Brazil
| | - Klícia Novais Quental
- Outpatient Clinic of Pediatric Dermatology, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP),
São Paulo (SP), Brazil
| | - Luciana Paula Samorano
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo (SP),
Brazil
| | - Zilda Najjar Prado de Oliveira
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo (SP),
Brazil
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Malissen N, Vergely L, Simon M, Roubertie A, Malinge MC, Bessis D. Long-term treatment of cutaneous manifestations of tuberous sclerosis complex with topical 1% sirolimus cream: A prospective study of 25 patients. J Am Acad Dermatol 2017; 77:464-472.e3. [PMID: 28502378 DOI: 10.1016/j.jaad.2017.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data on long-term topical sirolimus treatment of the cutaneous manifestations of tuberous sclerosis complex are rare. OBJECTIVE To evaluate the long-term benefit and tolerance of topical 1% sirolimus in tuberous sclerosis complex. METHODS In this 18-month prospective single-center study, 1% sirolimus cream was applied daily to facial angiofibromas (FAs), fibrous cephalic plaques (FCPs), shagreen patches, hypomelanotic macules, and ungual fibromas. After complete clearance (CC) of FAs, we evaluated a maintenance protocol of 3 applications weekly. RESULTS Twenty-five patients were enrolled. Fifty percent obtained CC of FAs within 9 months. Of 7 patients with CC (58%) who were following the maintenance protocol, 6 relapsed within 7 months and 1 was still responding at 1 year. Of 16 patients with FCPs, 7 (44%) remained stable at 12 months and 9 (56%) improved after 3 to 9 months of treatment. Only 1 of 5 patients treated for shagreen patches showed improvement at 12 months. Treatment was well tolerated with no serious adverse events. LIMITATIONS The small number of patients was a limitation. CONCLUSIONS Topical 1% sirolimus applied daily produced positive responses in treatment of FAs, FCPs, and facial hypomelanotic macules and was well tolerated. A 3-times-weekly maintenance protocol did not prevent FA relapses.
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Affiliation(s)
- Nausicaa Malissen
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - Laurence Vergely
- Department of Clinical Pharmacy and Oncology, Lapeyronie Hospital, Montpellier, France
| | - Marguerite Simon
- Department of Clinical Pharmacy and Oncology, Lapeyronie Hospital, Montpellier, France
| | - Agathe Roubertie
- Department of Neuropediatric and Regional Center of Competence of Tuberous Sclerosis, Gui de Chauliac Hospital, Montpellier, France
| | | | - Didier Bessis
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France; Regional Center of Competence for Rare Skin Disorders, Montpellier, France.
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Jóźwiak S, Sadowski K, Kotulska K, Schwartz RA. Topical Use of Mammalian Target of Rapamycin (mTOR) Inhibitors in Tuberous Sclerosis Complex-A Comprehensive Review of the Literature. Pediatr Neurol 2016; 61:21-7. [PMID: 27222056 DOI: 10.1016/j.pediatrneurol.2016.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tuberous sclerosis complex is a genetically determined multisystem disorder that may affect almost any human organ. The discovery of the mammalian target of rapamycin (mTOR) pathway and its involvement in tuberous sclerosis complex-related pathology has led to the introduction of mTOR inhibitors into clinical practice. Topical administration of mTOR inhibitors for skin lesions related to tuberous sclerosis complex may represent a reasonable alternative for more invasive procedures. A growing number of patients have been described exhibiting positive therapeutic effects from the topical administration of these agents. The aim of this review was to systematically analyze available literature on the use of topical mTOR inhibitors to treat dermatologic lesions related to tuberous sclerosis complex. RESULTS A comprehensive review of PubMed, Medscape, and Cochrane databases between 1995 and 2015 was performed to identify available studies describing topical use of mTOR inhibitors in individuals with tuberous sclerosis complex. In most studies, topical mTOR inhibitor application proved to be effective in the treatment of skin lesions related to tuberous sclerosis complex. Facial angiofibromas were the target lesions in most instances. Few studies reported clinical improvement of hypomelanotic macules. These drugs directly address the molecular defect related to tuberous sclerosis complex manifestations. CONCLUSIONS Currently available clinical data suggest that topical application of mTOR inhibitors may be effective in the treatment of facial angiofibromas associated with tuberous sclerosis complex. Ongoing randomized clinical trials of topical mTOR inhibitors for TSC-related cutaneous lesions should add clarity to the role of these agents.
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Affiliation(s)
- Sergiusz Jóźwiak
- Department of Pediatric Neurology, Warsaw Medical University, Warsaw, Poland; Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Krzysztof Sadowski
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland.
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Robert A Schwartz
- Department of Dermatology, Rutgers University, New Jersey Medical School, Newark, New Jersey; Department of Pediatrics, Rutgers University, New Jersey Medical School, Newark, New Jersey; Department of Preventive Medicine and Community Health, Rutgers University, New Jersey Medical School, Newark, New Jersey; Rutgers University School of Public Affairs and Administration, Newark, New Jersey
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9
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Vasani RJ. Facial angiofibromas of tuberous sclerosis treated with topical sirolimus in an Indian patient. Indian J Dermatol 2015; 60:165-9. [PMID: 25814705 PMCID: PMC4372909 DOI: 10.4103/0019-5154.152516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Facial angiofibromas are the most visible and unsightly of all the cutaneous manifestations of tuberous sclerosis (TSC). A 17-year-old female, a known case of TSC, presented for the treatment of cosmetically disfiguring facial angiofibromas. She was started on twice daily application of 0.1% sirolimus ointment prepared from crushed tablets of sirolimus compounded in white soft paraffin. After 3 months of use, there was visible decrease in the erythema and the size of the angiofibromas. In an attempt to accelerate the response, the concentration was further increased to 1% sirolimus which was used for a month, resulting in a decrease not only in the size and redness but also in the number of the angiofibromas. The patient did not experience any cutaneous or systemic complications related to therapy. Sirolimus belongs to a novel class of anticancer drugs known as mTOR (mammalian target of Rapamycin) inhibitors. Sirolimus has been used as a targeted therapy for the renal and neurological manifestations of TSC. Topical preparation of sirolimus is not commercially available till date and hence preparations from crushed tablets or oral solution of sirolimus have been used with beneficial effects in treatment of angiofibromas especially in younger patients with flatter lesions. Randomized controlled trials are necessary to enable us to confirm the efficacy, long-term safety, the optimal dosage and possibility of reappearance once the drug is withdrawn. This is possibly the first case report of the use of topical sirolimus in India.
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Affiliation(s)
- Resham J Vasani
- Department of Dermatology, K J Somaiya Hospital and Research Centre, Sion, Mumbai, Maharashtra, India
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Díaz-Ley B, Grillo E, Ríos-Buceta L, Paoli J, Moreno C, Vano-Galván S, Jaén-Olasolo P. Classic Kaposi's sarcoma treated with topical rapamycin. Dermatol Ther 2014; 28:40-3. [DOI: 10.1111/dth.12182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Blanca Díaz-Ley
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Emiliano Grillo
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Luis Ríos-Buceta
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - John Paoli
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Carmen Moreno
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Sergio Vano-Galván
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Pedro Jaén-Olasolo
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
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11
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Knöpfel N, Martín-Santiago A, Bauza A, Hervás J. Topical 0.2% Rapamycin to Treat Facial Angiofibromas and Hypomelanotic Macules in Tuberous Sclerosis. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Rapamicina tópica al 0,2% para el tratamiento de angiofibromas faciales y máculas hipomelanóticas en la esclerosis tuberosa. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:802-3. [DOI: 10.1016/j.ad.2013.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/03/2013] [Accepted: 09/08/2013] [Indexed: 01/09/2023] Open
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Balestri R, Neri I, Patrizi A, Angileri L, Ricci L, Magnano M. Analysis of current data on the use of topical rapamycin in the treatment of facial angiofibromas in Tuberous Sclerosis Complex. J Eur Acad Dermatol Venereol 2014; 29:14-20. [DOI: 10.1111/jdv.12665] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 06/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- R. Balestri
- Department of Specialized, Clinical and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
| | - I. Neri
- Department of Specialized, Clinical and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
| | - A. Patrizi
- Department of Specialized, Clinical and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
| | - L. Angileri
- Department of Specialized, Clinical and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
| | - L. Ricci
- Department of Specialized, Clinical and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
| | - M. Magnano
- Department of Specialized, Clinical and Experimental Medicine; Division of Dermatology; University of Bologna; Bologna Italy
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Park J, Yun SK, Cho YS, Song KH, Kim HU. Treatment of Angiofibromas in Tuberous Sclerosis Complex: The Effect of Topical Rapamycin and Concomitant Laser Therapy. Dermatology 2013; 228:37-41. [DOI: 10.1159/000357033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
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Koenig MK, Hebert AA, Roberson J, Samuels J, Slopis J, Woerner A, Northrup H. Topical rapamycin therapy to alleviate the cutaneous manifestations of tuberous sclerosis complex: a double-blind, randomized, controlled trial to evaluate the safety and efficacy of topically applied rapamycin. Drugs R D 2013; 12:121-6. [PMID: 22934754 PMCID: PMC3585992 DOI: 10.2165/11634580-000000000-00000] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives Facial angiofibromas are disfiguring facial lesions, present in up to 80% of patients with tuberous sclerosis complex. Recent elucidation of the complex cell signaling pathways that are disrupted in tuberous sclerosis indicates that rapamycin may be successful in alleviating the appearance of these lesions. The objectives of the current study were to evaluate the safety of topically applied rapamycin in patients with tuberous sclerosis complex and to determine its potential effectiveness in treatment of facial angiofibromas. Patients and Methods The study was a prospective, randomized, double-blind, placebo-controlled study performed at the University of Texas Health Science Center at Houston. Study subjects were recruited from the patient populations at the University of Texas Tuberous Sclerosis Center of Excellence. All subjects were over the age of 13 years and had a diagnosis of tuberous sclerosis complex. Subjects were excluded if they were using any form of rapamycin or if they were pregnant. Study subjects applied the study product to their facial angiofibromas nightly for a duration of 6 months. The investigational product contained one of three doses of rapamycin compounded with Skincerity®: (i) no rapamycin; (ii) 1 mg of rapamycin per 30 cc (0.003%); or (iii) 5 mg of rapamycin per 30 cc (0.015%). Plasma rapamycin concentrations were measured monthly to test for systemic absorption. Complete blood counts were performed monthly to test for anemia, neutropenia, or thrombocytopenia. Upon completion of the trial, subjects were asked if the formulation had improved the appearance of their facial angiofibromas. Results Twenty-three subjects completed the study. There was no detectable systemic absorption of rapamycin (all blood concentrations were <1.0 ng/mL). There were no significant changes in white blood cell, red blood cell, or platelet counts. Seventy-three percent of subjects in the treatment arms versus 38% of subjects in the placebo arm reported a subjective improvement in the appearance of their facial angiofibromas. Conclusion The application of low-dose topical rapamycin (0.003–0.015%) to the face can safely decrease the appearance of facial angiofibromas in patients with tuberous sclerosis complex. Trial Registration ClinicalTrials.gov Identifier: NCT01031901
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Affiliation(s)
- Mary Kay Koenig
- Division of Child Adolescent Neurology, Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX 77030, USA.
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