Tacrolimus in dermatologic disorders

OBJECTIVE: To review the data surrounding the use of tacrolimus for skin disorders. DATA SOURCES: Articles were obtained through a MEDLINE search of English-language literature (1990-May 2000); references of the retrieved publications were further reviewed for relevant literature. STUDY SELECTION: Original studies in humans regarding the use of tacrolimus for skin disorders were included. DATA EXTRACTION: The major outcomes extracted from the literature involved patient response to therapy and adverse effects. DATA SYNTHESIS: Tacrolimus offers an additional therapeutic approach to the treatment of immunologically based skin disorders. Controlled trials and case reports indicate topical tacrolimus is a sate and effective alternative treatment in patients with atopic dermatitis. Case reports document efficacy in recalcitrant pyoderma gangrenosum, mucosal lichen planus, and ichthyosis linearis circumflexa. Controlled trials and case reports indicate oral tacrolimus is effective in recalcitrant plaque psoriasis. Case reports document efficacy in recalcitrant pyoderma gangrenosum and leukocytoclastic vasculitis. The clinical utility of oral tacrolimus in skin disorders is limited due to potentially severe adverse effects such as infections, hypertension, hyperglycemia, hyperkalemia, nephrotoxicity, neurotoxicity, and increased risk of neoplasia. CONCLUSIONS: Most of the available data indicate short-term (3 wk to 3 mo) topical tacrolimus is a safe and effective treatment alternative for inflammatory skin disorders. Further study is needed to evaluate long-term safety and efficacy and to determine the best dosage regimen. Although oral tacrolimus has demonstrated efficacy in inflammatory skin disorders, the potential for serious adverse effects limits its utility to third-line therapy for patients who are resistant to, or intolerant of, conventional therapies.