Tacrolimus 0.3% in Clobetasol 0.05% ointment

BackgroundVascularized composite allotransplantation (VCA) offers unique reconstructive solutions for severe tissue loss, restoring form and function. Acute and chronic rejection remains a significant barrier, with acute episodes occurring in most recipients and chronic rejection persisting as the leading cause of graft failure. Unlike solid organ transplantation, VCA involves highly immunogenic tissues, like skin and mucosa, making rejection more frequent and challenging to manage.MethodsA systematic review was conducted following PRISMA 2020, searching PubMed/MEDLINE, EMBASE, and Web of Science for original human VCA studies reporting immunosuppressive protocols and outcomes in acute or chronic rejection. Quality was assessed using the Newcastle-Ottawa Scale and Level of Evidence; extracted data included demographics, regimens, rejection episodes, treatments, and graft survival.ResultsFourty-six studies (136 recipients) met inclusion criteria: upper extremity (n=69; 51%), face (n=33; 24%), abdominal wall (n=33; 24%), scalp and penile (each n=1; 0.7%). Acute rejection occurred in 81/136 (60%) within year 1, most often at POW 1-2 (n=52), 5-12 (n=42), and 13-52 (n=30). Severity was Banff grade I (n=49; 36%), II (n=73; 54%), III (n=50; 37%), and severe IV (n=1; 0.7%). Common symptoms included skin lesions (n=43; 32%), edema (n=32; 24%), erythema (n=29; 21%), and rash (n=15; 11%), with some experiencing numbness (n=4; 2.9%), tingling (n=5; 3.7%), or burning sensations (n=5; 3.7%). Corticosteroids were the mainstay (n=98; 72%)-methylprednisolone (n=31; 23%), clobetasol (n=15; 11%), and prednisone (n=11; 8.1%); tacrolimus was used in 49 (36%), including topical in 29 (21%). Other immunosuppressants included antithymocyte globulin (n=19; 14%), alemtuzumab (n=11; 8.1%), mycophenolate mofetil (n=11; 8.1%), and rituximab (n=6; 4.4%); basiliximab (n=4; 2.9%), sirolimus (n=2; 1.5%), and plasmapheresis (n=4; 2.9%) were used selectively. Monotherapy was used in 42 episodes, and dual therapy in 51, most commonly methylprednisolone plus topical tacrolimus (n=26).ConclusionThis review underscores the ongoing challenge of rejection in VCA and the need for improved treatment strategies, with corticosteroids, calcineurin inhibitors, and mycophenolate mofetil remaining standard while emerging biologicals offer promise. Acute rejection is often manageable yet threatens graft survival, whereas chronic rejection is less reported, likely under-recognized and harder to treat, underscoring need for novel immunomodulators, standardized protocols, and prevention to improve outcomes.

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BackgroundEstablishing effective treatment for cutaneous lupus erythematosus (CLE) is of major importance given lack of approved medications for this autoimmune condition. Topical calcineurin inhibitors have been used to treat all types of CLE, yet there is currently no robust study that evaluated the efficacy of calcineurin inhibitors in this patient population. Our aim is to study the efficacy of topical calcineurin inhibitors for treating patients with CLE and assess the side effects associated with the use of this class of medications.Materials and methodsA systematic review was conducted following the AMSTAR guidelines. A systematic search for articles published between 2003 and 2024 in PubMed, MEDLINE, the Cochrane library (Cochrane Databases of Systematic Reviews), and the Cochrane Register of Controlled Trials for relevant studies that assessed the efficacy of calcineurin inhibitors in patients with CLE.ResultsTwenty-five studies met the criteria, and we reviewed and collectively included. Based on the Quality assessment, some concerns are raised in the quality assessment of RCTs studies. However, Observational studies have high methodological quality.ConclusionIn conclusion, our systematic review analyzed 25 studies to evaluate the efficacy and safety of topical calcineurin inhibitors in treating CLE. Our systematic review findings support the effectiveness of these inhibitors, namely pimecrolimus cream and tacrolimus ointment in improving clinical manifestations and disease activity in various forms of CLE, such as discoid lupus and subacute CLE. However, the result from RCTs metanalysis showed no significant difference between calcineurin inhibitors and other treatments. While calcineurin inhibitors are generally safe, the most common side effect was skin burning sensation at application site in the first few days of treatment. Further research is needed to prove the effectiveness of these drugs, explore the comparative effectiveness between different calcineurin inhibitors and comparing their types and their concentration.

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Introduction: Annular Lichen Planus (ALP) of the penis is a rare variant of genital lichen planus. Clinically, it is characterized by violaceous plaques with an annular configuration and central clearing. The diagnosis can be challenging, especially considering its rarity, and histopathological confirmation is often necessary to differentiate it from other annular dermatoses. Methods: We report a rare case of genital ALP in a male patient, while reviewing previously reported cases to provide a comprehensive overview of this rare condition. Results: A 63-year-old white male was referred to our outpatient department presenting with symptomatic annular erythematous-violaceous lesions on the glans penis. A diagnosis of genital ALP was clinically suspected and subsequently confirmed by histopathology. The patient was started on topical tacrolimus 0.1% ointment twice daily, achieving a complete clinical resolution after 6 consecutive weeks of treatment. No signs of local recurrence were observed after a one-year follow-up. We carried out a systematic review of the literature which identified a limited number of similar cases. Conclusions: This review underscores the importance of clinical suspicion and biopsy for accurate diagnosis and effective management of penile ALP. Topical tacrolimus 0.1% ointment is a safe and effective treatment for penile ALP and can be used as an alternative of corticosteroids.

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BackgroundAdvancements in surgical techniques and immunosuppressive therapies have transformed care for patients through vascularized composite allotransplantation (VCA). However, lifelong systemic immunosuppression (SI) carries significant risks, specifically during acute rejection (AR), which typically requires increasing SI dosages. Mitigating such risks may be achieved through topical tacrolimus (TT). Although TT shows promise for VCA in preclinical studies, robust clinical data are lacking. This systematic review aims to evaluate the clinical use of TT in VCA.MethodsA systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using Cochrane, PubMed, Scopus, and Web of Science. Studies included patients who underwent VCA and received TT treatment. Study details, patient demographics, VCA characteristics, Banff grade, induction and SI maintenance protocols, complications, AR episodes, and treatment plans following these episodes were collected.ResultsThe search yielded 271 articles; 11 met inclusion criteria, encompassing 15 VCA recipients (mean age 39.9 y). Thirty-two AR episodes were reported; 22 (68.8%) involved TT. TT was mostly used in Banff grade I-II AR episodes. Resolution occurred in 65.5% of TT-treated episodes, though this finding was not statistically significant. TT was frequently used with steroids and adjunct therapies.ConclusionsThis systematic review highlights the potential role that TT may play in mitigating the need for increased doses of SI during AR episodes. As clinical data continue to grow, further research is essential to establish the potential benefits and efficacy of TT use in VCA.

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