Hypertrichosis ciclosporin

For ciclosporin evidence available from small studies is mixed, some suggesting efficacy in inducing remission (at the risk of adverse effects which include neuropathy and hypertrichosis) and others giving little evidence of benefit. 

VASODILATOR ANTIHYPERTENSIVES CICLOSPORIN 1. Co-administration of bosentan and cidosporin leads to t bosentan and 1 cidosporin levels 2. Risk of hypertrichosis when minoxidil given with cidosporin 3. t sitaxentan levels 1. Additive effect both drugs inhibit the bile sodium export pump, which is associated with hepatotoxicity 2. Additive effect 3. Uncertain 1. Avoid co-administration of bosentan and cidosporin 2. Warn patients of the potential interaction 3. Avoid co-administration... 

Ciclosporin sometimes causes chronic inflammatory dermatitis, and there have been two reports of four male transplant recipients who developed clinical and histo-pathological features of keloid acne of the posterior scalp or neck (152,153). Staphylococcus aureus infection was identified in three. Ciclosporin-induced hypertrichosis was suggested as a possible cause, with local bacterial infection and immunosuppression as trigger factors. 

The pathogenesis of juxtaclavicular beaded lines is unclear. Some authors have reported a prevalence of 16% in heart transplant patients, but only in men. Becanse ciclosporin is highly lipophilic, it has many adverse effects associated with alterations of pilosebaceous follicles, snch as hypertrichosis and acne. In this case the authors postulated that the combined effect of prednisone and ciclosporin may have induced sebaceous gland hyperplasia. 

Widespread hypertrichosis is one of the most common complications of ciclosporin, and distichiasis (accessory eyelashes) has been reported in one patient (SEDA-20, 345). Ciclosporin-associated soft tissue proliferation with an abnormal hyperplastic reaction has been suggested to account for the development of hyperplastic pseudofolliculitis barbae (159). 

A particular feature of minoxidil is excessive hair growth (7), which occurs in about 70% of patients who take oral minoxidil, usually within 2 months of the start of therapy. Severe hypertrichosis, unacceptable even to men, has comphcated the otherwise successful antihypertensive treatment of six patients after renal transplantation, for which ciclosporin was also used. Since hypertrichosis has also been described with ciclosporin, there may be an additive pharmacodynamic interaction (8). 

The concurrent use of ciclosporin and minoxidil can cause excessive hairiness (hypertrichosis). 

Six male kidney transplant patients taking ciclosporin (blood levels of 100 to 200 nanograms/mL) were given methyidopa, a diuretic and minoxidil 15 to 40 mg daily for intractable hypertension. After 4 weeks of treatment all of them complained of severe and unpleasant hypertrichosis (excessive hairiness). Two months after stopping the minoxidil the hypertrichosis had significantly improved. Both ciclosporin and minoxidil cause hypertrichosis and it would seem that their effects may be additive. The authors of the report point out that this is not a life-threatening problem, but it limits the concurrent use of these drugs in both men and women. ... 

Hair Hypertrichosis and darkening of the hair occurred in a 59-year-old man who took ciclosporin 2.5 mg/kg/day for 2 months [15 ]. 

---