Two cases of Zoon's balanitis treated with pimecrolimus 1% cream

Background Plasma cell balanitis is a disorder of the middle‐aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy. Methods We decided to evaluate the efficacy and tolerability of pimecrolimus 1% cream in resistant Zoon's balanitis. We report two cases of resistant Zoon's balanitis treated with topical pimecrolimus 1% cream. Results One of the two patients had a complete regression of the lesion after 2 months of therapy. The other one had a great improvement of the lesion, but a hyperpigmented patch persisted on the glans. Conclusion Pimecrolimus 1% cream may be a valuable second‐line treatment for patients with steroid related side effects or with steroid and other conventional therapy resistant Zoon's balanitis, as well as for those rejecting circumcision.     

外用1%吡美莫司乳膏治疗白癜风临床疗效观察

【摘要】：目的：观察局部外用1%吡美莫司乳膏治疗白癜风的临床疗效及安全性。方法：给予49例白癜风患者1%吡美莫司乳膏,每日2次外用,每两个月随访一次,观察治疗后靶皮损复色情况。结果：49例患者共计53处皮损,外用1%吡美莫司乳膏4-6个月后,22例达到不同程度的复色,有效率为55.10％,显效率为22.45%。除了2例患者用药后出现面部痤疮,其它无任何不良反应。结论：局部外用1%吡美莫司乳膏治疗白癜风疗效较好,不良反应少。     

Unsuccessful treatment of extragenital lichen sclerosus with topical 1% pimecrolimus cream

Lichen sclerosus most commonly affects the anogenital region. Spreading into the extragenital regions is rare, and its course is most commonly asymptomatic. Women have been reported to be affected 6 to 10 times more often than men. The etiology of lichen sclerosus is still unknown. The disease is characterized by ivory-white atrophic plaques, and no treatment ensuring complete recovery is available. T-cells are also involved in its pathogenesis. Pimecrolimus is a topical inhibitor of T-cells. In the present paper, we present a male patient with lichen sclerosus located only in extragenital regions and report an unsuccessful outcome of treatment with pimecrolimus 1% cream administered topically twice a day for 16 weeks.     

Letter: Generalized lichen nitidus successfully treated with pimecrolimus 1 percent cream

An eight-year-old child presented with generalized popular eruptions of two years duration. The diagnosis was lichen nitidus with pathologic confirmation. The lesions were successfully reduced and flattened by pimecrolimus 1 percent cream for 8 weeks.     

Topical 0.05% clobetasol propionate versus 1% pimecrolimus ointment in vitiligo

Vitiligo is a common skin condition resulting from loss of normal melanin pigments in the skin which produces white patches. Topical corticosteroids are indicated for the treatment of limited areas of vitiligo. Pimecrolimus, which inhibits calcineurin, has recently been shown to be effective for the treatment of vitiligo. We performed a prospective study to evaluate the efficacy of the 0.05% clobetasol propionate and 1% pimecrolimus in the treatment of vitiligo. Ten patients with virtually bilateral symmetrical lesions of vitiligo were included. 0.05% clobetasol propionate was applied twice daily over the lesion on right side of the body, and topical 1% pimecrolimus was applied twice daily over the lesion on left side of the body. It was determined that both treatment modalities resulted in a comparable rate of repigmentation. Response to treatment was varied according to the anatomical location of the lesions where better results were seen on the trunk and extremities. Results from this pilot study indicate that topical 1% pimecrolimus is as effective as clobetasol propionate in restoring skin disfiguring due to vitiligo. For a better conclusive statement further studies involving larger groups of patients should be performed.     

Development and pre-clinical aspects of pimecrolimus

Pimecrolimus (SDZ ASM 981), an ascomycin derivative, inhibits the phosphatase calcineurin and blocks the production of inflammatory cytokines in T cells. In contrast to corticosteroids, pimecrolimus has a cell selective mode of action, exerting e.g. no effect on dendritic cells, which have a central function in the skin-associated immune system. Pimecrolimus shows less permeation through skin than corticosteroids and tacrolimus which indicates a lower potential for systemic side effects after topical application. In animal models pimecrolimus has a marked dose-dependent anti-inflammatory activity. However, treatment with pimecrolimus does not induce skin atrophy in contrast to corticosteroids. In contrast to tacrolimus, pimecrolimus does not impair the primary immune reaction in the sensitization phase of allergic contact dermatitis and has generally less effect on systemic immune reactions. In summary, the pharmacological profile of pimecrolimus suggests high clinical efficacy together with excellent safety.     

Allergic contact dermatitis to pimecrolimus

Pimecrolimus suppresses the proinflammatory cytokine production of cutaneous T and mast cells (1). It is used to treat atopic dermatitis and is the active ingredient in the topical formulation pimecrolimus 1.0% cream (Elidel, Novartis Pharma AG, Basel, Switzerland).     

Antipruritic effects of pimecrolimus and tacrolimus

The development of topical calcineurin inhibitors resulted in a significant improvement in the treatment of inflammatory skin diseases such as atopic dermatitis. In addition, an excellent amelioration of pruritus could be observed. Other itchy dermatoses such as chronic irritative hand dermatitis, rosacea, graft-versus-host-disease, renal pruritus, lichen sclerosus, prurigo simplex, prurigo nodularis, scrotal eczema, and inverse psoriasis also have been treated successfully with pimecrolimus and tacrolimus. The antipruritic effect currently is believed to be related to the inhibition of inflammatory cytokines. Furthermore, recent investigations indicate a release of neuropeptides from sensory nerve fibers and degranulation of mast cells mediated by pimecrolimus and tacrolimus. Similar effects have been observed during capsaicin treatment. These findings may provide a possible explanation for initially observed calcineurin inhibitors related side-effects such as burning and pruritus. Moreover, the antipruritic potency may be related to a direct effect on nerve fibers leading to suppression of itch mediated by unknown mechanisms.     

Improvement in pruritus in children with atopic dermatitis using pimecrolimus cream 1%

The objective of this study was to assess time to onset of pruritus improvement in a pediatric population treated with pimecrolimus cream 1%. This 8-day, double-blinded, vehicle-controlled study randomized 174 children and adolescents (aged 2-17 years) with mild to moderate atopic dermatitis (AD) and moderate to severe pruritus to twice-daily applications of pimecrolimus cream 1% or vehicle. There were no significant between-group differences in demographics or baseline disease characteristics. Pruritus was assessed by subjects using a 4-point pruritus severity scale (0-3). The primary efficacy variable was time to a 1 point or more improvement in pruritus score from baseline. The 2 treatment groups were compared using log-rank testing of the time-to-event data. In the per-protocol (PP) population, median times to a 1 point or more improvement in pruritus score were 48 and 72 hours for pimecrolimus and vehicle groups, respectively (P = .038). From day 3 onward, significantly more subjects (P = .023) in the pimecrolimus group versus the vehicle group reported complete pruritus resolution. Pimecrolimus cream 1% improved pruritus within 48 hours in children and adolescents with mild to moderate AD and achieved complete resolution of pruritus in a significantly greater number of subjects in the pimecrolimus group versus the vehicle group by the end of the 7-day treatment period (P = .008).     

Discordant results with pimecrolimus 1% cream in the treatment of plasma cell balanitis

Plasma cell balanitis of Zoon is a chronic, benign, inflammatory dermatosis of the glans penis and prepuce. The exact aetiology is unknown. The treatments described to date have provided only partially successful results. Recently, several reports of plasma cell balanitis successfully treated with calcineurin inhibitors have been published. We report 3 cases of plasma cell balanitis refractory to several treatments with steroids and antifungals treated with pimecrolimus 1% cream applied twice daily: 1 patient had a complete resolution, 1 patient had a marked response but relapsed during the treatment and the last patient had a partial response due to the development of a side effect that precociously required to stop the treatment. One patient referred a slight pruritus after the first applications of the cream that spontaneously disappeared after a few minutes. Additional experiences are needed to determine if topical pimecrolimus is an effective and safe treatment for plasma cell balanitis.