Role of Topical Calcineurin Inhibitors in the Treatment of Seborrheic Dermatitis
Bethany A. Cook; Erin M. Warshaw
Abstract
Seborrheic dermatitis (SD) is characterized by erythematous pruritic patches and plaques with greasy scale that occur in sebaceous areas. It is common, affecting up to 3% of the population. Past treatments have relied on a wide variety of anti-inflammatory and antifungal agents, but corticosteroids have limited use because of long-term adverse effects. ical calcineurin inhibitors provide a safe alternative for the treatment of SD, as these drugs block the inflammatory cascade involved in the disease process and pose no risk of skin atrophy. Studies of ical pimecrolimus and tacrolimus in the treatment of SD have found that improvement occurred within 2 weeks, and if SD recurred after sping treatment, it was significantly less severe. There have been no studies of the comparative efficacy of pimecrolimus versus tacrolimus for the treatment of SD.
Seborrheic dermatitis (SD) is characterized by erythematous pruritic patches and plaques with greasy scale that occur in sebaceous areas. It is common, affecting up to 3% of the population. Past treatments have relied on a wide variety of anti-inflammatory and antifungal agents, but corticosteroids have limited use because of long-term adverse effects. ical calcineurin inhibitors provide a safe alternative for the treatment of SD, as these drugs block the inflammatory cascade involved in the disease process and pose no risk of skin atrophy. Studies of ical pimecrolimus and tacrolimus in the treatment of SD have found that improvement occurred within 2 weeks, and if SD recurred after sping treatment, it was significantly less severe. There have been no studies of the comparative efficacy of pimecrolimus versus tacrolimus for the treatment of SD.
Common adverse effects of mild burning and irritation have been associated with the use of both of these agents. Safety profile studies are limited to studies of aic dermatitis, which show no increase in infection rate, photocarcinogenicity, or signs of immunosuppression in patients using ical calcineurin inhibitors for long-term treatment. This article reviews the clinical trials of pimecrolimus and tacrolimus in the treatment of SD, focusing on efficacy and safety.
Introduction
Seborrheic dermatitis (SD) is an inflammatory skin condition affecting approximately 1-3% of the adult population. The chronic, relapsing course, associated symptoms, and emotional impact of SD can affect quality of life. The heterogeneity of SD is evident in the variety of clinical presentations and absence of uniform diagnostic criteria. The disease is more prevalent in male than female patients, and its incidence peaks in infants, adolescents, and adults over the age of 50 years. There is a higher rate of occurrence in immunocompromised patients, ranging from 30% to 83% in HIV-positive and AIDS patients, and 18-50% in individuals with Parkinson disease.
The large proportion of people affected by SD spurs continued interest in the etiology and treatment of this condition. While studies have shown SD to be linked to a variety of endogenous and exogenous factors, the specific etiology of the condition remains elusive. The chronic course of the disease necessitates treatment that is both effective and safe to use as long-term therapy. Historically,treatment of SD has relied heavily on keratolytics, antifungals, and corticosteroids. The development of ical immunomodulatory medications has provided an alternative therapy for chronic inflammatory skin disorders, and the use of pimecrolimus and tacrolimus in SD has been investigated in several clinical trials. This article reviews the pathogenesis and current therapy of SD, focusing on recent evidence regarding the safety and efficacy of the ical calcineurin inhibitors tacrolimus and pimecrolimus. Articles evaluated for this review included manuscripts written in English referenced in PubMed, Ovid, and/or the Cochrane library with the following search terms: 'seborrheic dermatitis', 'ical calcineurin inhibitors', 'safety', 'efficacy', 'pimecrolimus', and 'tacrolimus'.
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Introduction
Seborrheic dermatitis (SD) is an inflammatory skin condition affecting approximately 1-3% of the adult population. The chronic, relapsing course, associated symptoms, and emotional impact of SD can affect quality of life. The heterogeneity of SD is evident in the variety of clinical presentations and absence of uniform diagnostic criteria. The disease is more prevalent in male than female patients, and its incidence peaks in infants, adolescents, and adults over the age of 50 years. There is a higher rate of occurrence in immunocompromised patients, ranging from 30% to 83% in HIV-positive and AIDS patients, and 18-50% in individuals with Parkinson disease.
The large proportion of people affected by SD spurs continued interest in the etiology and treatment of this condition. While studies have shown SD to be linked to a variety of endogenous and exogenous factors, the specific etiology of the condition remains elusive. The chronic course of the disease necessitates treatment that is both effective and safe to use as long-term therapy. Historically,treatment of SD has relied heavily on keratolytics, antifungals, and corticosteroids. The development of ical immunomodulatory medications has provided an alternative therapy for chronic inflammatory skin disorders, and the use of pimecrolimus and tacrolimus in SD has been investigated in several clinical trials. This article reviews the pathogenesis and current therapy of SD, focusing on recent evidence regarding the safety and efficacy of the ical calcineurin inhibitors tacrolimus and pimecrolimus. Articles evaluated for this review included manuscripts written in English referenced in PubMed, Ovid, and/or the Cochrane library with the following search terms: 'seborrheic dermatitis', 'ical calcineurin inhibitors', 'safety', 'efficacy', 'pimecrolimus', and 'tacrolimus'.
DOWNLOAD COMPLETE PDF HERE
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