[New horizons in the treatment of atopic dermatitis]

Macrolactam Immunomodulators (Tacrolimus and Pimecrolimus): New Horizons in the Topical Treatment of Inflammatory Skin Diseases

Tacrolimus and pimecrolimus are new macrolactam immunomodulators which were developed for the treatment of inflammatory skin diseases, mainly atopic dermatitis. In this article, we review the pharmacologic properties of the drugs, their side effects, and their clinical uses.

A derivative of L-allo threonine alleviates 2,4-dinitrofluorobenzene-induced atopic dermatitis indications

LX519290, a synthetic derivative from a combinatorial chemistry library, has been screened for anti-atopic activity, but its biological activities have not yet been elucidated. To assess whether LX519290 has the potential to lessen 2,4-dinitrofluorobenzene-induced atopic dermatitis symptoms in mice, first we sensitized the skin in the dorsal neck of C57BL/6 mice and re-sensitized the ear skin to determine the ear thickness. Then, we tested to determine whether LX519290 affect atopic dermatitis symptoms in vivo. The results indicate that LX519290 significantly mitigated inflammation indications including ear thickness, total T-cell numbers, and eosinophils. Moreover, the treatment drastically inhibited the levels of mediators such as interleukin-17E and histamine by 52% and 37% of control, respectively. Taken together, the data suggest that LX519290 can alleviate atopic parameters in mice.

Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis

OBJECTIVES

To build a critical appraisal of the available literature to evaluate the effectiveness of topical calcineurin inhibitors in treatment of atopic dermatitis (AD), in comparison to topical corticosteroids (TCs) and/or placebo.

REVIEW METHODS

DESIGN

systematic review and meta-analysis.

DATA SOURCES

electronic search of MEDLINE Pubmed along the last 10 years (1997-2006).

STUDY SELECTION

randomized control trials of TCIs reporting efficacy outcomes, in comparison to TCs or vehicle (placebo) or both.

DATA SYNTHESIS

of 210 articles, 19 studies were included, 10 for tacrolimus and 9 for pimecrolimus, involving 7378 patients of whom 2771 applied tacrolimus, 1783 applied pimecrolimus, and 2824 were controls. Both drugs were significantly more effective than a vehicle. However, two long-term trials comparing demonstrated the value of pimecrolimus in reduction of flares and steroid-sparing effect after 6 months. Compared to TCs, both 0.1% and 0.03% tacrolimus ointments were as effective as moderate potency TCs, and more effective than a combined steroid regimen. Tacrolimus was more effective than mild TCs.

CONCLUSIONS

TCIs in AD are more effective than placebo. Although less effective than TCs, pimecrolimus has its value in long-term maintenance and as a steroid-sparing agent in AD, whenever used early enough, at first appearance of erythema and/or itching. In treatment of moderate to severe AD, topical tacrolimus is as effective as moderately potent TCs, and more effective than mild preparations. Chronic AD lesions of the face and flexures are the most justified indication for topical calcineurin inhibitors.