Calcineurin Inhibitors (Non-steroidal Therapies) Psoriasis help

Calcineurin inhibitors (also known as topical immunomodu-lators or TIMs) are a new class of therapy that has been recently approved in the United States and Canada for the treatment of atopic dermatitis/eczema. Their use in treatment of psoriasis is being investigated. They work by inhibiting a key step in the activation of the T lymphocyte: a cell in the immune system that is important in causing the skin changes of psoriasis and atopic dermatitis. There are two types of calcineurin inhibitors:

In the treatment of psoriasis, calcineurin inhibitors have had variable success. Initial clinical research failed to prove any benefit of topical tacrolimus or pimecrolimus in the treatment of psoriasis when applied to thick, scaly areas. There is evidence, however, that both these agents are effective when used for psoriasis on sites such as the face, groin or armpits. These areas are particularly vulnerable to thinning of the skin when treated with topical steroids, which makes these new agents valuable additions as thinning of the skin has not been reported with either tacrolimus or pimecrolimus.Psoriasis help

Since calcineurin inhibitors are non-steroidal, they lack many of the side effects that can occur with topical steroids. The major side effect seen with tacrolimus or pimecrolimus is temporary burning on the skin. This tends to last for only a few minutes after application and generally resolves on its own within a week to 10 days of therapy. Unfortunately, these agents are significantly more expensive than topical steroids.

Topical tacrolimus is currently available in ointment form as a 0.03 to 0.1% concentration (10 g, 30 g, 60 g and 100 g tubes). Topical pimecrolimus is available in a 1% concentration cream (30 g, 60 g and 100 g tubes), only as a prescription.

Currently, there is ongoing clinical research to develop new bases such as creams, ointments or gels. Pimecrolimus in pill form is currently being tested for use in chronic plaque-type psoriasis, and the initial clinical results have been very encouraging.

Tazarotene Psoriasis help

Tazarotene is a topical vitamin A derivative available in a gel or cream. Tazarotene is effective predominantly in reducing scaling and thickness of plaques but is less successful in reducing redness. When prescribed alone, the use of tazarotene is limited because many patients develop significant irritation at the site of application. Irritation can be reduced if tazarotene is used in combination with other topical steroids.

Tazarotene increases the skin's photosensitivity and has been successfully combined with both ultraviolet-B and narrowband ultraviolet-B therapy to provide more effective and rapid clearing of psoriasis versus either treatment alone. Tazarotene should not be used during pregnancy.
Psoriasis help

Click to continue
Top of page Psoriasis Treatment 5