Continuing medical education
The use of cyclosporine in dermatology: Part I

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Cyclosporine is a calcineurin inhibitor that acts selectively on T cells. It has been used in dermatology since 1997 for its US Food and Drug Administration indication of psoriasis and off-label for various other inflammatory skin conditions, including atopic dermatitis, blistering disorders, and connective tissue diseases. In the last decade, many dermatologists have hesitated to use this important drug in their clinical practices because of its toxicity profile. The purpose of this article is to review the mechanism of action of cyclosporine and its current uses and dosing schedules. It is our goal to create a framework in which dermatologists feel comfortable and safe incorporating cyclosporine into their prescribing regimens.

Learning objectives

After completing this learning activity, participants should be able to describe the mechanism of action of cyclosporine, recognize the potential role of cyclosporine in dermatology and the evidence to support this role, and incorporate cyclosporine into his or her prescribing regimens.

Section snippets

History

Key points

  1. Cyclosporine was first used to prevent rejection in solid organ transplant recipients

  2. 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

  1. 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

  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

  1. Cyclosporine is useful for the short-term treatment of psoriasis and atopic dermatitis

  2. Multiple case reports have shown cyclosporine to have excellent results when used for the treatment of pyoderma gangrenosum

  3. 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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      Citation Excerpt :

      Cyclosporine was initially used to prevent rejection in solid organ transplant recipients and was later approved for psoriasis. In addition, cyclosporine has been used to treat various dermatologic conditions, such as atopic dermatitis, pyoderma gangrenosum, and refractory chronic idiopathic urticaria.26 In the literature review, Harman et al13 reported the first case of using cyclosporine as an alternative treatment for a patient with steroid-dependent DRESS in 2003.

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    Bruce H. Thiers, MD, Editor, has disclosed the following financial relationships: Elsevier- Other/Honoraria, Galderma- Other/Honoraria, Graceways Pharmaceuticals- Consultant/Honoraria. Dirk M. Elston, MD, Deputy Editor, has disclosed the following financial relationships: Intendis- Investigator/No Compensation. Robert T. Brodell, MD, JAAD CME Planner, has disclosed the following financial relationships: 3M/Graceway Pharmaceuticals- Speaker/Honoraria, Allergan- Speaker/Honoraria, Dermik/BenzaClin- Speaker/Honoraria, Dow Pharmaceutical Sciences- Consultant/Honoraria, Galderma Laboratories, LP- Speaker/Honoraria, GlaxoSmithKline- Speaker/Honoraria, Graceway Pharmaceuticals, LLC- Speaker/Honoraria, Medicis- Advisory Board/Honoraria, Novaritis Pharmaceuticals- Speaker/Honoraria, Promius- Advisory Board/Honoraria, Sanofi-Aventis- Speaker/Honoraria. Joseph C. English III, MD, JAAD CME Planner, has disclosed the following financial relationships: Centocor- Investigator/No compensation. James R. Treat, MD, JAAD CME Planner, has disclosed the following financial relationships: Pierre Fabre-Investigator/Grants. Hensin Tsao, MD, JAAD CME Planner, has disclosed the following financial relationships: Genentech- Consultant/Honoraria, Quest Diagnostics- Consultant/Honoraria, SciBASE-Consultant/Honoraria. Matthew Zirwas, MD, JAAD CME Planner, has disclosed the following financial relationships: Astellas Pharmaceuticals- Speaker/Honoraria, Coria Laboratories- Speaker/Honoraria, Consultant/Honoraria, Onset Therapeutics-Consultant/Honoraria. Caitrona Ryan, MBBCh, BAO, Author, has disclosed the following financial relationships: Abbott-Other/Grant, Galderma- Advisory Board/Honoraria. Alan Menter, MD, Author, has disclosed the following financial relationships: Abbott- Advisory Board/Grant, Consultant/Honoraria, Investigator/Honoraria, Speaker/Honoraria, Amgen-Speaker/Honoraria, Advisory Board/Grant, Astellas- Consultant/Grant, Advisory Board/Honoraria, Celgene-Investigator/Grant, Centocor- Advisory Board/Honoraria, Consultant/Grant, Eli Lilly- Investigator/Grant, Galderma-Advisory Board/Honoraria, Speaker/Honoraria, Genentech- Advisory Board/Grant, Novartis- Investigator/Grant, Novo Nordisk- Investigator/Grant, Pfizer- Investigator/Grant, Promius-Investigator/Grant, Stiefel-Investigator/Grant, Syntrix-Investigator/Grant, Warner Chilcott-Advisory Board/Honoraria, Wyeth-Advisory Board/Honoraria, Speaker/Honoraria, Investi-gator/Grant. All other authors, editors, planners, peer reviewers, and staff have no relevant financial relationships.

    Reprints not available from the authors.

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