Continuing medical educationThe use of cyclosporine in dermatology: Part I
Section snippets
History
Key points Cyclosporine was first used to prevent rejection in solid organ transplant recipients Cyclosporine was approved by the US Food and Drug Administration for the treatment of psoriasis in 1997
In 1970, cyclosporine, also known as cyclosporin A (CsA), was isolated from the soil fungus Tolypocladium inflatum Gams by Borel at Sandoz Laboratories in Basel, Switzerland, while looking for novel antifungal agents.1 Although it was initially noted to have only a narrow antifungal spectrum, cyclosporine was
Mechanism of action
Key points Cyclosporine forms a complex with cyclophilin, which inactives calcineurin phosphorylase, preventing the phosphorylation of nuclear factor of activated T cells and, therefore, the transcription of interleukin-2 Interleukin-2 is required for full activation of the T-cell pathway
Cyclosporine was the first immunosuppressive drug found to act selectively on T cells. The helper T cell is the main target, but the T suppressor cell may also be affected. Cyclosporine forms a complex with cyclophilin, an
Clinical uses of cyclosporine and regimens
Key points Cyclosporine is useful for the short-term treatment of psoriasis and atopic dermatitis Multiple case reports have shown cyclosporine to have excellent results when used for the treatment of pyoderma gangrenosum Cyclosporine is useful for the treatment of refractory chronic idiopathic urticaria
Conclusion
Cyclosporine continues to play an important role in the field of dermatology. We strongly recommend cyclosporine for short-term “rescue” treatment of psoriasis and atopic dermatitis in appropriate patients. Although randomized controlled trials have not been undertaken, multiple case reports have also shown excellent results when cyclosporine is used for the treatment of pyoderma gangrenosum. We also recommend cyclosporine for treatment of refractory chronic idiopathic urticaria and
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