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Blauvelt A, Draelos ZD, Stein Gold L, Alonso-Llamazares J, Bhatia N, DuBois J, Forman SB, Gooderham M, Green L, Guenthner ST, Hebert AA, Lain E, Moore AY, Papp KA, Zirwas M, Kato S, Snyder S, Krupa D, Burnett P, Berk DR, Chu DH. Roflumilast foam 0.3% for adolescent and adult patients with seborrheic dermatitis: A randomized, double-blinded, vehicle-controlled, phase 3 trial. J Am Acad Dermatol 2024; 90:986-993. [PMID: 38253129 DOI: 10.1016/j.jaad.2023.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The topical phosphodiesterase 4 inhibitor roflumilast has been studied in several dermatologic conditions. OBJECTIVE Roflumilast foam 0.3% is being investigated as a topical treatment for seborrheic dermatitis (SD). METHODS In this phase 3, double-blinded trial, patients with SD were randomly assigned (2:1 ratio) to once-daily roflumilast foam 0.3% or vehicle foam for 8 weeks. The primary efficacy outcome was Investigator Global Assessment (IGA) Success at week 8, defined as IGA of 0 (Clear) or 1 (Almost Clear) plus ≥2-point improvement from baseline. Safety was also assessed. RESULTS 79.5% of roflumilast-treated and 58.0% of vehicle-treated patients met the primary endpoint (P < .001); statistically significant differences in IGA Success also favored roflumilast at week 2 (roflumilast: 43.0%; vehicle: 25.7%; P < .001) and week 4 (roflumilast: 73.1%; vehicle: 47.1%; P < .001). Roflumilast was well-tolerated with a low rate of treatment-emergent adverse events. LIMITATIONS Study limitations include the 8-week treatment period for this chronic condition. CONCLUSIONS Once-daily roflumilast foam was superior to vehicle in leading to IGA of Clear or Almost Clear plus ≥2-point improvement from baseline at 8 weeks in patients with SD. Longer trials are needed to determine durability and safety of roflumilast foam in SD.
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Affiliation(s)
| | - Zoe D Draelos
- Dermatology Consulting Services, High Point, North Carolina
| | | | | | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, California
| | | | | | - Melinda Gooderham
- SKiN Centre for Dermatology, Probity Medical Research and Queen's University, Peterborough, Ontario, Canada
| | - Lawrence Green
- George Washington University School of Medicine, Rockville, Maryland
| | - Scott T Guenthner
- The Dermatology Center of Indiana, PC, Plainfield, Indiana; The Indiana Clinical Trials Center, PC, Plainfield, Indiana
| | | | | | - Angela Y Moore
- Arlington Research Center, Arlington, Texas; Baylor University Medical Center, Dallas, Texas
| | - Kim A Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Matthew Zirwas
- Dermatologists of the Central States, Cincinnati, Ohio; Probity Medical Research, Waterloo, Ontario, Canada; Ohio University, Bexley, Ohio
| | - Saori Kato
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | - Scott Snyder
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | - David Krupa
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | | | - David R Berk
- Arcutis Biotherapeutics, Inc., Westlake Village, California
| | - David H Chu
- Arcutis Biotherapeutics, Inc., Westlake Village, California
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Madu PN, Syder N, Elbuluk N. Postinflammatory hypopigmentation: a comprehensive review of treatments. J DERMATOL TREAT 2020; 33:704-708. [DOI: 10.1080/09546634.2020.1793892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pamela N. Madu
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
| | - Nicole Syder
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
| | - Nada Elbuluk
- USC Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
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Abstract
Seborrheic dermatitis (SD) is a chronic, recurring inflammatory skin disorder that manifests as erythematous macules or plaques with varying levels of scaling associated with pruritus. The condition typically occurs as an inflammatory response to Malassezia species and tends to occur on seborrheic areas, such as the scalp, face, chest, back, axilla, and groin areas. SD treatment focuses on clearing signs of the disease; ameliorating associated symptoms, such as pruritus; and maintaining remission with long-term therapy. Since the primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation, the most commonly used treatment is topical antifungal and anti-inflammatory agents. Other broadly used therapies include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, phototherapy, among others. Alternative therapies have also been reported, such as tea tree oil, Quassia amara, and Solanum chrysotrichum. Systemic therapy is reserved only for widespread lesions or in cases that are refractory to topical treatment. Thus, in this comprehensive review, we summarize the current knowledge on SD treatment and attempt to provide appropriate directions for future cases that dermatologists may face.
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Affiliation(s)
- Luis J Borda
- a Department of Dermatology & Cutaneous Surgery , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Marina Perper
- a Department of Dermatology & Cutaneous Surgery , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Jonette E Keri
- a Department of Dermatology & Cutaneous Surgery , University of Miami Miller School of Medicine , Miami , FL , USA.,b Veterans Affairs Miami Health Care System , Miami , FL , USA
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Zhao J, Sun W, Zhang C, Wu J, Le Y, Huang C, Liu Y, Xiang L. Comparison of different regimens of pimecrolimus 1% cream in the treatment of facial seborrheic dermatitis. J Cosmet Dermatol 2017; 17:90-94. [PMID: 28589618 DOI: 10.1111/jocd.12353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pimecrolimus 1% cream has already been proved to be an effective and safe alternative to treat seborrheic dermatitis. However, the treatment periods were inconstant in previous studies. OBJECTIVE To evaluate the comparative efficacy of pimecrolimus 1% cream with different regimens for the treatment of facial seborrheic dermatitis. METHOD Thirty patients with facial seborrheic dermatitis were enrolled and randomly distributed to three groups. Patients of Group 1 were treated with topical pimecrolimus cream 1% twice daily for 2 weeks and then a moisturizer cream twice daily for 2 weeks. Patients of Group 2 were treated with pimecrolimus cream 1% twice daily for 2 weeks and then once daily for another 2 weeks. Patients of Group 3 had a consecutive course of pimecrolimus cream 1% twice daily for 4 weeks. Objective symptoms, subjective symptoms, and dermatology life quality index (DLQI) were measured at weeks 0, 2, 4, and 6. RESULTS At week 4, the clinical severity scores of all three regimens significantly decreased (P<.01). The improvement of total severity score in Group 3 was more remarkable than groups 1 and 2 (both P<.05). This effect was maintained until the end of the study in Group 3. Life quality of all three groups was significantly improved at week 4 (P<.001), while there was no statistical difference on the improvement of life quality among three groups. CONCLUSION We recommend pimecrolimus 1% cream could be applied twice a day for 4 weeks to treat seborrheic dermatitis.
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Affiliation(s)
- Juemin Zhao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjia Sun
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaqiang Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Le
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chunyun Huang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkkä J, Oravilahti T, Rannanheimo PK, Verbeek JH. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Cochrane Database Syst Rev 2014; 2014:CD009446. [PMID: 24838779 PMCID: PMC6483543 DOI: 10.1002/14651858.cd009446.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Seborrhoeic dermatitis is a chronic inflammatory skin disorder affecting primarily the skin of the scalp, face, chest, and intertriginous areas, causing scaling and redness of the skin. Current treatment options include antifungal, anti-inflammatory, and keratolytic agents, as well as phototherapy. OBJECTIVES To assess the effects of topical pharmacological interventions with established anti-inflammatory action for seborrhoeic dermatitis occurring in adolescents and adults. SEARCH METHODS We searched the following databases up to September 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 9), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We searched five trials databases and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs in adults or adolescents (> 16 years) with diagnosed seborrhoeic dermatitis of the scalp or face, comparing topical anti-inflammatory treatments (steroids, calcineurin inhibitors, and lithium salts) with other treatments. DATA COLLECTION AND ANALYSIS Pairs of authors independently assessed eligibility for inclusion, extracted data, and evaluated the risk of bias. We performed meta-analyses if feasible. MAIN RESULTS We included 36 RCTs (2706 participants), of which 31 examined topical steroids; seven, calcineurin inhibitors; and three, lithium salts. The comparative interventions included placebo, azoles, calcipotriol, a non-steroidal anti-inflammatory compound, and zinc, as well as different anti-inflammatory treatments compared against each other. Our outcomes of interest were total clearance of symptoms, erythema, scaling or pruritus scores, and adverse effects. The risk of bias in studies was most frequently classified as unclear, due to unclear reporting of methods.Steroid treatment resulted in total clearance more often than placebo in short-term trials (four weeks or less) (relative risk (RR) 3.76, 95% confidence interval (CI) 1.22 to 11.56, three RCTs, 313 participants) and in one long-term trial (lasting 12 weeks). Steroids were also more effective in reducing erythema, scaling, and pruritus. Adverse effects were similar in both groups.There may be no difference between steroids and calcineurin inhibitors in total clearance in the short-term (RR 1.08, 95% 0.88 to 1.32, two RCTs, 60 participants, low-quality evidence). Steroids and calcineurin inhibitors were found comparable in all other assessed efficacy outcomes as well (five RCTs, 237 participants). Adverse events were less common in the steroid group compared with the calcineurin group in the short-term (RR 0.22, 95% CI 0.05 to 0.89, two RCTs, 60 participants).There were comparable rates of total clearance in the steroid and azole groups (RR 1.11, 95% CI 0.94 to 1.32, eight RCTs, 464 participants, moderate-quality evidence) as well as of adverse effects in the short-term, but less erythema or scaling with steroids.We found mild (class I and II) and strong (class III and IV) steroids comparable in the assessed outcomes, including adverse events. The only exception was total clearance in long-term use, which occurred more often with a mild steroid (RR 0.79, 95% CI 0.63 to 0.98, one RCT, 117 participants, low-quality evidence).In one study, calcineurin inhibitor was more effective than placebo in reducing erythema and scaling, but there were similar rates in total clearance or adverse events for short-term treatment. In another study, calcineurin inhibitor was comparable with azole when erythema, scaling, or adverse effects were measured for longer-term treatment.Lithium was more effective than placebo with regard to total clearance (RR 8.59, 95% CI 2.08 to 35.52, one RCT, 129 participants) with a comparable safety profile. Compared with azole, lithium resulted in total clearance more often (RR 1.79, 95% CI 1.10 to 2.90 in short-term treatment, one RCT, 288 participants, low-quality evidence). AUTHORS' CONCLUSIONS Topical steroids are an effective treatment for seborrhoeic dermatitis of the face and scalp in adolescents and adults, with no differences between mild and strong steroids in the short-term. There is some evidence of the benefit of topical calcineurin inhibitor or lithium salt treatment. Treatment with azoles seems as effective as steroids concerning short-term total clearance, but in other outcomes, strong steroids were more effective. Calcineurin inhibitor and azole treatment appeared comparable. Lithium salts were more effective than azoles in producing total clearance.Steroids are similarly effective to calcineurin inhibitors but with less adverse effects.Most of the included studies were small and short, lasting four weeks or less. Future trials should be appropriately blinded; include more than 200 to 300 participants; and compare steroids to calcineurin inhibitors or lithium salts, and calcineurin inhibitors to azoles or lithium salts. The follow-up time should be at least one year, and quality of life should be addressed. There is also a need for the development of well-validated outcome measures.
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Affiliation(s)
- Helena Kastarinen
- Finnish Medicines Agency FimeaAssessment of PharmacotherapiesP.O. Box 55FimeaFinland00034
| | - Tuija Oksanen
- Finnish Medicines Agency FimeaAssessment of PharmacotherapiesP.O. Box 55FimeaFinland00034
| | - Enembe O Okokon
- University of Calabar Teaching HospitalDepartment of Community Medicine13 Mbukpa RoadCalabarCross River StateNigeria540001
| | - Vesa V Kiviniemi
- Finnish Medicines AgencyAssessment of PharmacotherapiesMicrokatu 1KuopioFinland70210
| | - Kristiina Airola
- Finnish Medicines Agency FimeaAssessment of Medicinal ProductsP.O. Box 55FimeaFinland00034
| | - Johanna Jyrkkä
- Finnish Medicines Agency FimeaAssessment of PharmacotherapiesP.O. Box 55FimeaFinland00034
| | - Tuomas Oravilahti
- Finnish Medicines Agency FimeaAssessment of PharmacotherapiesP.O. Box 55FimeaFinland00034
| | - Piia K Rannanheimo
- Finnish Medicines Agency FimeaAssessment of PharmacotherapiesP.O. Box 55FimeaFinland00034
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Work Review GroupPO Box 310KuopioFinland70101
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Ang-Tiu CU, Meghrajani CF, Maano CC. Pimecrolimus 1% cream for the treatment of seborrheic dermatitis: a systematic review of randomized controlled trials. Expert Rev Clin Pharmacol 2014; 5:91-7. [DOI: 10.1586/ecp.11.68] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Salam A, Aryiku S, Dadzie O. Hair and scalp disorders in women of African descent: an overview. Br J Dermatol 2013; 169 Suppl 3:19-32. [PMID: 24098898 DOI: 10.1111/bjd.12534] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 12/19/2022]
Affiliation(s)
- A. Salam
- Imperial College Healthcare NHS Trust; London U.K
| | - S. Aryiku
- Nottingham University Hospitals NHS Trust; Nottingham U.K
| | - O.E. Dadzie
- Department of Dermatology and Histopathology; The North West London Hospitals NHS Trust; Northwick Park Hospital; Watford Road; Harrow HA1 3UJ U.K
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Kim JH, Kim BY, Choi JW, Kim SO, Lee HS, Park KC, Youn SW. The objective evaluation of the severity of psoriatic scales with desquamation collecting tapes and image analysis. Skin Res Technol 2011; 18:143-50. [PMID: 21507073 DOI: 10.1111/j.1600-0846.2011.00545.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Assessment of psoriatic scales is important to determine the severity of psoriasis. However, there are very limited numbers of objective, quantitative and observer-independent tools for measuring the severity of psoriasis. OBJECTIVE To determine whether the bioengineering parameters of the psoriatic scale can be used to assess the severity of psoriasis instead of the psoriatic severity index of scales (PSIs) score. METHODS Thirty-four patients with psoriasis were included. A representative lesion from each patient was selected and bioengineering parameters were measured using the Corneofix(®). Simultaneously, the severity of the scales was assessed by the PSIs score using clinical photographs of the lesions. In addition, skin color and elasticity parameters were also measured using the Colorimeter(®), the Mexameter(®) and the Cutometer(®). RESULTS Statistical differences in the scale parameters were observed between the PSIs 2 and 3 scores. Among the scale parameters, the percent area and area in μm(2) were negatively correlated with the PSIs score. In addition, the Colorimeter(®) a, b parameters and the Cutometer(®) R9 parameters were significantly correlated with the PSIs score. CONCLUSIONS The results of this study showed that the severity of psoriatic scales could be measured objectively using the Corneofix(®).
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Affiliation(s)
- J H Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Tatlican S, Eren C, Oktay B, Eskioglu F, Durmazlar PK. Experience with repetitive use of pimecrolimus: Exploring the effective and safe use in the treatment of relapsing seborrheic dermatitis. J DERMATOL TREAT 2010. [DOI: 10.3109/09546630902882055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Semih Tatlican
- Department of Dermatology, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Cemile Eren
- Department of Dermatology, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Bilgen Oktay
- Department of Dermatology, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Fatma Eskioglu
- Department of Dermatology, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Pelin Kartal Durmazlar
- Department of Dermatology, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Tatlican S, Eren C, Eskioglu F. Insight into pimecrolimus experience in seborrheic dermatitis: Close follow-up with exact mean cure and remission times and side-effect profile. J DERMATOL TREAT 2009; 20:198-202. [DOI: 10.1080/09546630802684692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koc E, Arca E, Kose O, Akar A. An open, randomized, prospective, comparative study of topical pimecrolimus 1% cream and topical ketoconazole 2% cream in the treatment of seborrheic dermatitis. J DERMATOL TREAT 2009; 20:4-9. [PMID: 18677657 DOI: 10.1080/09546630802286993] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol 2009; 10:103-18. [PMID: 19222250 DOI: 10.2165/00128071-200910020-00003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Seborrheic dermatitis (SD) is characterized by erythematous pruritic patches and plaques with greasy scale that occur in sebaceous areas. It is common, affecting up to 3% of the population. Past treatments have relied on a wide variety of anti-inflammatory and antifungal agents, but corticosteroids have limited use because of long-term adverse effects. Topical calcineurin inhibitors provide a safe alternative for the treatment of SD, as these drugs block the inflammatory cascade involved in the disease process and pose no risk of skin atrophy. Studies of topical pimecrolimus and tacrolimus in the treatment of SD have found that improvement occurred within 2 weeks, and if SD recurred after stopping treatment, it was significantly less severe. There have been no studies of the comparative efficacy of pimecrolimus versus tacrolimus for the treatment of SD. Common adverse effects of mild burning and irritation have been associated with the use of both of these agents. Safety profile studies are limited to studies of atopic dermatitis, which show no increase in infection rate, photocarcinogenicity, or signs of immunosuppression in patients using topical calcineurin inhibitors for long-term treatment. This article reviews the clinical trials of pimecrolimus and tacrolimus in the treatment of SD, focusing on efficacy and safety.
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Affiliation(s)
- Bethany A Cook
- University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Day I, Lin AN. Use of pimecrolimus cream in disorders other than atopic dermatitis. J Cutan Med Surg 2008; 12:17-26. [PMID: 18258153 DOI: 10.2310/7750.2008.07026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pimecrolimus is indicated for treatment of atopic dermatitis and has been evaluated in many other disorders. OBJECTIVE To review the efficacy of pimecrolimus in treatment of disorders other than atopic dermatitis. METHODS We performed a PubMed search of the English-language literature using the key word "pimecrolimus." We reviewed articles reporting the use of pimecrolimus in disorders other than atopic dermatitis and classified them by the type of study used to evaluate efficacy. RESULTS Randomized, double-blind studies have shown that pimecrolimus is superior to vehicle in treatment of seborrheic dermatitis, hand dermatitis, and asteatotic eczema but have yielded conflicting results regarding intertriginous psoriasis and vitiligo. Open-label studies involving four or more patients have shown favorable results in many disorders, including contact dermatitis, rosacea, lichen sclerosus, and oral and genital lichen planus. Case reports have shown that topical pimecrolimus may be useful in cutaneous graft-versus-host disease, lichen striatus, cutaneous lichen planus, and many other disorders. CONCLUSIONS Topical pimecrolimus appears to be an effective treatment for many disorders other than atopic dermatitis, especially seborrheic dermatitis, hand dermatitis, and asteatoic eczema. It may be effective in many other disorders, but its role in these disorders remains to be clarified by additional studies.
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Affiliation(s)
- Isaiah Day
- Division of Dermatology and Cutaneous Sciences, University of Alberta, Edmonton, AB, Canada
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Wollina U. The role of topical calcineurin inhibitors for skin diseases other than atopic dermatitis. Am J Clin Dermatol 2007; 8:157-73. [PMID: 17492844 DOI: 10.2165/00128071-200708030-00003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The topical calcineurin inhibitors (TCIs) pimecrolimus and tacrolimus are approved for atopic dermatitis but have additional potential in other inflammatory skin diseases. This article reviews their clinical use in non-atopic dermatitis diseases. In seborrheic dermatitis, asteatotic eczema, and contact dermatitis, TCIs are of great benefit and can compete with topical corticosteroids. In psoriasis, TCIs have shown clinical efficacy and safety in facial and intertriginous lesions. Further investigations into possible combinations of TCIs with other established treatments such as UVB irradiation in this disorder are necessary. Initial studies in cutaneous lupus erythematosus have been promising, whereas the response in rosacea and rosacea-like eruptions has been mixed. TCIs have been associated with good clinical responses in oral lichen planus and anogenital lichen sclerosus et atrophicus. In vitiligo, TCIs are associated with some degree of repigmentation, with better results being seen in children and in facial and neck areas. TCIs have a synergistic effect with UVB irradiation in vitiligo. There is a long list of small series and case reports documenting use of TCIs in various other skin conditions that warrant further validation. Although the established mode of action of TCIs is T-cell control, other effects also need to be considered. Specifically, TCIs reduce pruritus and erythema, which cannot be explained by T-cell interactions, and further investigations are needed in these fields.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
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Warshaw EM, Wohlhuter RJ, Liu A, Zeller SA, Wenner RA, Bowers S, Schultz JC, Katz HI, McCormick CL, Parneix-Spake A. Results of a randomized, double-blind, vehicle-controlled efficacy trial of pimecrolimus cream 1% for the treatment of moderate to severe facial seborrheic dermatitis. J Am Acad Dermatol 2007; 57:257-64. [PMID: 17188780 DOI: 10.1016/j.jaad.2006.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 10/24/2006] [Accepted: 11/03/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Seborrheic dermatitis is commonly treated with anti-inflammatory products, including topical corticosteroids. Pimecrolimus cream 1% also exerts anti-inflammatory activity by inhibiting T-cell cytokine production. OBJECTIVE We sought to compare the efficacy and safety of twice-daily pimecrolimus for treatment of moderate to severe facial seborrheic dermatitis. METHODS This double-blind, vehicle-controlled, 4-week trial randomized patients with seborrheic dermatitis to pimecrolimus or vehicle (1:1). Clinical assessments (erythema [0-3] and scaling [0-3] combined for a total area score [0-6]) were performed at weeks 0, 2, and 4. Inclusion criteria included total area score 4 or greater and erythema 2 or greater. The prespecified primary variable, change from baseline in total area score at week 4, was analyzed using a two-sample t test for intent-to-treat and per protocol populations. RESULTS In all, 96 adults of mean age 59.6 years, 88.5% male, were randomized (n = 47 pimecrolimus; 49 vehicle). At week 4, the mean change from baseline in total area score was 3.7 versus 3.3 for pimecrolimus and vehicle groups, respectively (intent-to-treat: P = .1913; 95% confidence interval (CI) for difference [-0.195, 0.961]). Per protocol analysis (n = 41 pimecrolimus; 46 vehicle) indicated a significant difference between groups (mean change 3.9 pimecrolimus vs 3.2 vehicle; P = .0156; CI [0.129, 1.197]). The superiority of pimecrolimus was observed as early as week 2 (intent-to-treat: P = .0062; CI [0.132, 0.777]; per protocol: P = .0012; CI [0.410, 1.593]). No drug-related serious adverse events occurred. The most frequent drug-related adverse events were local, mild, and transient (pimecrolimus = 26%; vehicle = 12%). LIMITATIONS Generalizability is limited by the elderly male study population. CONCLUSION This study suggests that pimecrolimus cream 1% is an effective and well-tolerated treatment for moderate to severe facial seborrheic dermatitis.
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Affiliation(s)
- Erin M Warshaw
- Minneapolis Department of Veterans Affairs Medical Center, University of Minnesota, Minneapolis MN 55417, USA.
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Wollina U, Hansel G, Koch A, Abdel-Naser MB. Topical pimecrolimus for skin disease other than atopic dermatitis. Expert Opin Pharmacother 2006; 7:1967-75. [PMID: 17020422 DOI: 10.1517/14656566.7.14.1967] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pimecrolimus is an ascomycin macrolactam. It is a specific calcineurin inhibitor that allows topical application. The highly lipophilic nature of this compound reduces the risk of systemic absorption through normal and inflammed skin. Pimecrolimus shows activity not only against T-cell activation, but also against mast cells and pruritus. Pimecrolimus 1% cream is approved for atopic dermatitis, and also has a great potential in other inflammatory skin diseases. Clinical trials have been performed in contact- and seborrhoeic dermatitis, genital lichen sclerosus, intertriginous psoriasis and cutaneous lupus erythematosus. In other diseases, the available data are limited to small case series, or individual cases of graft-versus-host disease or Netherton's disease. Although the use of calcineurin inhibitors in the treatment of vitiligo is promising, detailed studies with pimecrolimus and ultraviolet-irradiation are necessary and there is a need for prospective randomised, double-blind controlled trials.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology, Academic Teaching Hospital Dresden-Friedrichstadt, Germany
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