Atopic dermatitis cyclosporine

Tacrolimus is used in situations where cyclosporine has been shown to be ineffective or cannot be used because of toxicity or otherwise. It is also used in a topical preparation in the treatment of severe atopic dermatitis, severe refractory uveitis after bone marrow transplants and in vitiligo. 

It is an immunosuppressant macrolide antibiotic produced by Streptomyces tsukubaensis. Like cyclosporine, tacrolimus binds to a cytoplasmic immunophylin and the complex inhibits the activity of the calcium dependent phosphatase known as calcineurin. This in turn, inhibits the translocation of the transcription factor NF-AT into the cell nucleus, blocking the initiation of NF-AT dependent T-cell responses. It is indicated in atopic dermatitis. 

Mougel F, Dalle S, Baline B, Houot R, Thomas L. Aggressive CD30 large cell lymphoma after cyclosporine given for putative atopic dermatitis. Dermatology 2006 213 239-41. 

Ishii E, Yamamoto S, Sakai R, et al. Production of interleukin-5 and the suppressive effect of cyclosporin A in childhood severe atopic dermatitis. J Pediatr 1996 128 152-5. 

In severe, refractory cases, atopic dermatitis can be treated with ultraviolet radiation, oral corticosteroids, cyclosporine, azathioprine, methotrexate, and interferon-y. 

Sowden JM, Berth-Jones J, Ross JS, et al. Double-blind, controlled, crossover study of cyclosporin in adults with severe refractory atopic dermatitis. Lancet 1991 338 137-140. 

Berth-Jones J, Finlay AY, Zaki 1, et al. Cyclosporine in severe childhood atopic dermatitis a multicenter study. J Am Acad Dermatol 1996 34 1016-1021. 

Berth-Jones J, Graham-Brown RA, Marks R, et al. Long term efficacy and safety of cyclosporin in severe adult atopic dermatitis. Br J Dermatol 1997 136 76-81. 

Camp, R. D., Reitamo, S., Friedmann, P. S., and Heule, F. (1993). Cyclosporin A in severe, therapy-resistant atopic dermatitis Report of an international workshop. Br. J. Dermatol. 129,217-220. 

Salek, M. A., Finlay, A. Y., Luscombe, D. K., Allen, B. R., Berth-Jones, J., Kahn, G. K., Marks, R., Motley, R. J., Ross, J. S., and Sowden, J. M. (1993). Cyclosporin greatly improves the quality of life of adults with severe atopic dermatitis A randomized, double-blind placebo controlled trial. Br. J. Dermatol. 129,422-430. 

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