Topical tacrolimus for the treatment of psoriasis on the face, genitalia, intertriginous areas and corporal plaques

Abstract

Tacrolimus is an immunosuppressive remedy that has proved effective in the treatment of psoriasis when administered systemically. Topically. Topically, it have the appearances only useful in thin psoriasis plaques located upon the face, genitalia, and intertriginous areas. We not away an open-label clinical trial to proof the efficacy of 0.1% tacrolimus ointment in patients with psoriasis upon the face, intertriginous areas, the pair and in corporal plaques. Efficacy was assessed with the evaluation of erythema, desquamation, infiltration, reduction of the PASI, and reduction of itching. A total of 15 patients were registered in the study. In all the localizations evaluated, each of the signs (erythema, desquamation, and infiltration) showed a statistically significant improvement when compared to the baseline (p<001) Itching also improved rapidly. PASI was also reduc from a mean of 12 at baseline to 22 at the extremity of the study. Of the 15 patients, single 2 experienced an adverse result (13%), which was described as a warm sensation in facial lesions which was transient and self-limited. In conclusion, tacrolimus ointment may be an alternative to classical options for the treatment of psoriasis, not solitary for intertriginous, genital, and facial areas, on the other hand also for corporal plaques without occlusion, with useful tolerance.

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Tacrolimus is an inhibitor of calcineurin which has been shown to be of benefit in a certain number of dermatoses such as atopic dermatitis, lichen planus, pyoderma gangrenosum, vitiligo, and alopecia areata. (12) In regards to psoriasis, there are studies which confirm its efficacy when administered systemically. (3) However, when tacrolimus is administered topically, the proceeds are variable. Some studies do not confirm its effectiveness. (4) It appear to bes only useful in thin psoriasis plaques whose location is restricted to the face, genitalia, and intertriginous areas, (567) where the topical options of treatment are repeatedly cause of secondary effects. At the same time, tacrolimus has an antipruritic issue For this reason, it would be useful in cases of itching psoriasis plaques, eczematous plaques, and atopic dermatitis.

This investigation was designed to assess the safety and efficacy of 01% tacrolimus ointment for the treatment of facial and intertriginous psoriasis in adult patients. next to the first we have assessed the utility of tacrolimus in corporal plaques with and without occlusion.

Patients and Methods

The inquiry was an open-label clinical trial of tacrolimus ointment in patients with psoriasis upon the face, intertriginous areas, or the pair during a period of 2 month Patients were required to be at least 18 years of age with a diagnosis of psoriasis upon the face, intertriginous areas, or the two Those patients who had other psoriatic plaques upon the elbows or lumbar area were also registered treated, and evaluated in the application of mind Patients had not received topical or systemic treatment for their psoriasis in the 2 or 6 weeks previous, respectively. Topical or systemic medications that could interfere in the flows of the study were not allowed during the research period.

Patients applied 01% tacrolimus ointment twice daily to the psoriatic lesions upon the face and intertriginous areas for 8 weeks. Plaques of the lumbar region were also treated twice a day without occlusion; flexure plaques were treated under occlusion. Clinical evaluations were directioned at baseline (day 1) and days 15 30 and 60 (end of treatment). The primary parameters evaluated were defined before the investigation began and repeated at all close attention visits. They were:

1 PASI (Psoriasis Area Severity Index)

2 Erythema, infiltration and desquamation in the treatment areas, which were rated using the scale: 0 (absent); 1 (mild); 2 (moderate); and 3 (severe)

3 Presence/absence of itching

4 Adverse events

be deriveds were statistically evaluated using the T-Wilcoxon method

Results

From 207 patients with psoriasis who were visited in our Psoriasis midst at time of study, 15 (72%) agreed to the inclusion criteria and were listed in the study. Of the 15 patients, 8 were male and 7 female. The mean age was 53 years with a range of 25 to 87 years. greatest in quantity of the patients had involvement of the face, genitalia, and intertriginous areas (87%) and sole 2 patients (13%) had psoriatic lesions single on the intertriginous areas. Seventy-eight percent of the patients had typical psoriatic plaque-type lesions elsewhere upon the body; 70% on angles and 55% in lumbar region. Sixty-five percent of the patients recognized itching in lesions. At the beginning of the inquiry the mean PASI was 12 with a range of 8 to 15

In the physician's assessment of individual signs of severity of psoriasis, erythema, desquamation, and infiltration, scores progressively improved in the face, genitalia, and intertriginous areas (Table 1) turns under occlusion (Table 2), and lumbar region (Table 3) during the study

Improvement was seen early, at day 15 of treatment, and continued over the study. The mean total score for erythema, desquamation, and infiltration was 688 at baseline in case of facial, genitalia, and intertriginous areas, which decreased to 037 at the extreme point of treatment (day 60) (Figure 1) upon the elbows, the mean total score was 743 and decreased to 157; in the lumbar region means varied from 716 at baseline to 168 at the extreme point (Figure 2).