Topical steroids and topical tacrolimus appear safe in relation to the COVID-19 epidemic

PurposeInvestigation of the efficacy and safety of 12 months of topical tacrolimus 0.03% ointment treatment against the subepithelial infiltrates (SEIs) due to adenoviral keratoconjunctivitis (AKC) resisting at least 2 years was aimed.MethodsThis case series included consecutive patients with SEIs secondary to AKC who were resistant to topical steroid and ciclosporin-A (CSA) treatment and treated with topical 0.03% tacrolimus (Protopic; Fujisawa Healthcare, Teva, Deerfield, Illinois, USA) for 12 months, at least 2 years after AKC. For the evaluation of treatment efficacy, best-corrected visual acuity (BCVA), Fantes score, corneal subepithelial infiltrate score (CSIS), Oxford score, Schirmer and tear breakup time results were evaluated. Intraocular pressure and complaints of the patients were followed for evaluating the safety profile of the treatment. The patients were followed after the baseline visit at the 1st, 3rd, 6th and 12th month.Results15 eyes of 11 patients with SEIs and 16 eyes of 16 healthy controls were included in this study. 1 patient (9.1%) could not tolerate the treatment. Significant improvements in BCVA, CSIS, Fantes score and Schirmer results were observed in the study group starting from the 3rd-month visit, and the improvements persisted until the end of 12 months of treatment.ConclusionTopical 0.03% tacrolimus might show efficacy against the SEIs persisting at least 2 years despite corticosteroid and/or CSA treatment without any prominent side effect. While at least a period of 3 months was necessary for a significant improvement in the BCVA, SEIs and Schirmer results, a period of 6 months was necessary for a decrease in Oxford score.

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Cutaneous Plasmacytosis: A Pitfall For B and Plasma Cell Neoplasms

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.215 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S98-S98

Author(s):

C N Giraldo ◽

D Myers ◽

A Holmes ◽

J Dodd ◽

W Wendi

Keyword(s):

Plasma Cell ◽

Plasma Cells ◽

Plasma Cell Dyscrasia ◽

Topical Steroids ◽

Cell Infiltrate ◽

Systemic Involvement ◽

Topical Tacrolimus ◽

Plasma Cell Neoplasm ◽

Plasma Cell Neoplasms ◽

Intralesional Steroid

Abstract Introduction/Objective Cutaneous plasmacytosis (CP) is an uncommon condition typically affecting Asian males in the 3rd to 5th decades. It is thought to be a reactive process that classically presents with asymptomatic, red-brown, plaques and nodules on the face and neck. It has been associated with polyclonal hypergammaglobulinemia and systemic involvement. Histologically it is characterized by dense superficial and deep dermal infiltrates of mature plasma cells with polyclonal differentiation on in-situ hybridization (ISH). The differential diagnosis includes neoplastic plasma cell processes, characteristically with monoclonal plasma cell infiltrate, and mature B cell neoplasms with polyclonal plasma cell differentiation. Methods We report a case of a 69 year old Caucasian male who presented with asymptomatic, enlarging red-brown nodules on bilateral nasal ala. Histologic examination revealed dense, superficial plasma cell infiltrate, concerning for a plasma cell neoplasm. CD138 and Kappa/Lambda ISH demonstrated plasma cell polyclonality. Further workup ruled out infectious or systemic involvement and a plasma cell dyscrasia was ruled out by Hematology/Oncology. Results These findings supported the diagnosis of CP. Treatment with intralesional steroids showed initial improvement with regrowth of the nodules. To date, treatment with topical steroids and CO2 laser ablation are being considered. Conclusion CP is reported as type of pseudolymphoma, which is described as a reactive lymphoproliferation that histopathologically and/or clinically imitates cutaneous lymphoma. The pathogenesis is unknown, however, there are studies suggesting an association with increased interleukin-6, which is involved in the differentiation of B cells to mature plasma cells. The majority of patients with CP have a favorable prognosis. There has been variable success with both topical and intralesional treatment to include, cyclophosphamide, topical tacrolimus, prednisone, intralesional steroid therapy, topical psoralens combined with ultraviolet A exposure, and other chemotherapies. Familiarity with this rare entity is imperative to prevent misdiagnosis and overtreatment.

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Topical Tacrolimus in the Treatment of Erosive Pustular Dermatosis of the Scalp

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2007.00027 ◽

2007 ◽

Vol 11 (6) ◽

pp. 222-225 ◽

Cited By ~ 18

Author(s):

Marta J. Cenkowski ◽

Shane Silver

Keyword(s):

Light Exposure ◽

Therapeutic Option ◽

Rare Condition ◽

Initial Therapy ◽

Topical Steroids ◽

Topical Tacrolimus ◽

History Of ◽

Prevention Of Relapse

Background: Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation. Case History: A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth. Conclusion: This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.

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Successful treatment of granuloma faciale

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20205609 ◽

2020 ◽

Vol 7 (1) ◽

pp. 129

Author(s):

Sahar H. Alsharif ◽

Reda H. Saifaldeen ◽

Logain G. Alghanemi

Keyword(s):

Successful Treatment ◽

Topical Steroids ◽

Erythematous Plaque ◽

Gradual Improvement ◽

Topical Tacrolimus ◽

Therapeutic Modalities ◽

Granuloma Faciale ◽

The Face ◽

History Of

<p class="abstract">Granuloma faciale (GF) is a chronic condition characterized by asymptomatic erythematous plaque with prominent telangiectasia presenting usually over the face. Although the condition is benign, its treatment is often unsatisfactory. Therapeutic modalities that have been tried include topical steroids and topical tacrolimus sometimes enhanced with topical dapsone. Others include intralesional corticosteroids, antimalarials, isoniazid and pulsed-dye laser. We report a case of a 58 years old female with a 1 year history of a solitary slowly progressive plaque over the nose. Diagnosis of GF was made based on the histopathological findings. The patient was started on the combination of topical tacrolimus, intralesional corticosteroids injection and oral doxycycline for 3 months. The patient showed gradual improvement in 3 months without any side effects. This case supports previous papers of successful treatment of GF with topical tacrolimus. There was no recurrence at follow-up 18 months later. It also supports the use of combination therapy especially in resistant cases.</p>

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Intralymphatic Histiocytosis: An Unusual Presentation

Case Reports in Dermatology ◽

10.1159/000510128 ◽

2021 ◽

pp. 1-6

Author(s):

Timothy J. Blackwell ◽

Zachary Ingersoll ◽

Martin Blackwell

Keyword(s):

Inflammatory Disease ◽

Topical Steroids ◽

Anterior Neck ◽

Lower Lip ◽

Topical Tacrolimus ◽

Multiple Biopsies ◽

Primary Disorder ◽

History Of ◽

Legionnaires Disease ◽

Intralymphatic Histiocytosis

Intralymphatic histiocytosis (ILH) is a rare cutaneous condition initially described in 1994 by O’Grady et al. It often appears as a red to violaceous, livedoid patch or plaque usually on the extremities. We present a 71-year-old female with a history of psoriasis, 50 pack years smoking and recent Legionnaires disease who came to us complaining of a red to violaceous, blanching, edematous, mildly tender lesion covering the left lower lip and extending to the chin and anterior neck. After multiple biopsies, ILH was confirmed and the patient was initially started on tacrolimus 0.1% ointment b.i.d., but there was no response. Then, she was started on oral pentoxifylline and intermittent topical steroids, as well as continuing the topical tacrolimus. There was again no response, so now she is taking a TNF-ɑ inhibitor as it appears to be a granulomatous process. These ILH cases are very rare and there is limited literature that describes one treatment as a cure. Treatment of ILH is very difficult, but several different therapies have been reported with varying success. If the disease is secondary to an underlying inflammatory disease or malignancy, then treatment of the primary disorder can lead to resolution of the ILH.

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Efficacy of Topical Tacrolimus 0.05% Suspension in Steroid-Resistant and Steroid-Dependent Vernal Keratoconjunctivitis

10.53350/pjmhs211572150 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2150-2155

Author(s):

Mitra Akbari

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Corneal Opacity ◽

Vernal Keratoconjunctivitis ◽

Topical Steroids ◽

Steroid Resistant ◽

Topical Tacrolimus ◽

Steroid Dependent ◽

The Mean

Objective: The purpose of this study was to investigate the safety and effectiveness of topical tacrolimus 0.05% suspension in the management of prolonged steroid-dependent and -resistant vernal keratoconjunctivitis (VKC). Materials and methods: The present interventional prospective case series were conducted on the research units suffering from refractory VKC between 2017, April and 2020, December. Despite routine drug treatment, consisting of topical steroids (steroid-resistant group), all subjects exhibited active symptomatic illness or were dependent on topical steroids (steroid-dependent group). After discontinuation of all medications for at least 1 week, the patients received eye drop (topical tacrolimus 0.05%) minimally for six months. Objective and subjective signs and symptoms were examined for alterations after one week, and one and six months of treatment. Analyses were continued for probable systemic and ocular adverse effects. Results: The study included 28 eyes of 14 participants (including 4 females and 10 males), with the mean age of 22 ± 8 years (between 11 and 38 years), and the mean VKC duration of 12 ± 6 years (between 5 and 23 years), as well as follow up period of 10±2 months (between 6 and 12 months). The results showed an improvement (P<0.001) in the symptoms such as mucus discharge, foreign body sensation, photosensitivity, redness, burning and itching. The initial sign was conjunctival hyperemia, which improved one week after treatment. Other objective signs including, conjunctival and limbal papillary hypertrophy, corneal pannus and corneal punctate epithelial erosions improved at least one month after treatment. No changes were observed in corneal opacity during follow-up (p> 0.05). There were no systemic or ocular adverse effects. Conclusion: This is the first time that tacrolimus suspension drops 0.05%, are used in these cases. Topical tacrolimus 0.05% was shown to be an effectiveness and safe agent to treat the refractory VKC. This drug is recommended to be prescribed prior to the appearance of side effects such as corneal opacity, irreversible deficiency in limbal stem cell, and steroid side effects. Keywords: Vernal keratoconjunctivitis, Tacrolimus eye drop, Refractory

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Local immunosuppression in WZS-pig to rhesus monkey Descemet’s stripping automated endothelial keratoplasty: An innovative method to promote the survival of xeno-grafts

Ophthalmic Research ◽

10.1159/000521193 ◽

2021 ◽

Author(s):

Xu Li ◽

Ying Huang ◽

Qingfeng Liang ◽

Guoping Li ◽

Shutang Feng ◽

...

Keyword(s):

Rhesus Monkey ◽

Anterior Segment ◽

Control Group ◽

Topical Steroids ◽

Endothelial Keratoplasty ◽

Topical Tacrolimus ◽

Local Immunosuppression ◽

Long Time ◽

And Function ◽

Slit Lamp Microscopy

Corneal xenotransplantation is an effective solution for the shortage of human corneas. We investigated the feasibility and efficacy of different postoperative protocols on xeno-Descemet's stripping automated endothelial keratoplasty (DSAEK) grafts. Thirty rhesus monkeys were randomly divided into three groups: control group (C), only Descemet's membrane (DM) stripping; DSAEK 1 (D1) and DSAEK 2 (D2) groups, DM stripping followed by endothelial keratoplasty. Betamethasone 3.5 mg was subconjunctival injected in groups control and D1 postoperatively, while animals in group D2 were treated with topical 0.1% tacrolimus and topical steroids. All groups were evaluated by slit-lamp microscopy, anterior segment OCT and LSCM for at least nine months. A total of 24 monkeys (24 eyes) met the inclusion criteria. Nine months after DSAEK surgery, all xenografts showed good attachment, and most corneas were transparent. Graft rejection occurred in 25% of the cases in group D1 and 28.57% of those in group D2 (P > 0.05). The corneal endothelium density in the DSAEK groups was 2715.83±516.20/mm² (D1) and 2220.00 ± 565.13/mm² (D2) (P > 0.05). Xenogeneic corneal endothelial grafts can survive and function in rhesus monkey eyes for a long time with subconjunctival steroid or topical tacrolimus and steroid treatment.

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Topical tacrolimus in ocular Graft Versus Host Disease

10.21203/rs.3.rs-327505/v1 ◽

2021 ◽

Author(s):

Samir Shawki ◽

Khalid Tabbara

Keyword(s):

Graft Versus Host Disease ◽

Term Therapy ◽

Ocular Involvement ◽

Topical Steroids ◽

Eye Drops ◽

Conjunctival Hyperemia ◽

Host Disease ◽

Topical Tacrolimus ◽

Graft Versus Host ◽

Punctate Keratitis

Abstract Purpose: To evaluate the safety and efficacy of topical tacrolimus eye drops in the treatment of patients with ocular Graft Versus Host Disease (GVHD).MethodsTen consecutive patients with ocular GVHD were included retrospectively. All patients were treated with topical tacrolimus (0.01% - 0.03%) twice daily. Five patients were given adjunctive topical steroids for 4 to 6 weeks. The outcome measures included improvement of symptoms of photophobia, ocular pain and discharge and signs of superficial punctate keratitis and conjunctival hyperemia. Clinical assessment was carried out before, during and on the last visit after treatment.ResultsThere were 9 males and 1 female patients. The mean age was 30 years (range 5 to 51). All patients had bilateral ocular involvement. Duration of treatment ranged from 2 to 22 months (mean 6.5 months). There was improvement of symptoms in 8/10 (80%), superficial punctate keratitis in 8(40%) out of the 20 eyes and conjunctival hyperemia in 12 (66%) out of 18 eyes. The response to treatment was noted to be late following initiation of therapy (Average 3 weeks; range 1 to 8 weeks). Patients given adjunctive steroids responded faster. The main adverse ocular side effects were burning sensation, redness and swollen lids.ConclusionTopical tacrolimus is a safe and effective long-term therapy in the treatment of patients with ocular GVHD. Adjunctive short-term use of topical steroids may lead to faster response to topical tacrolimus therapy. Patients should be encouraged to continue use of topical tacrolimus as the onset of action may be delayed.

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