Which medications in the drug class Immunomodulators are used in the treatment of Atopic Dermatitis?

Updated: Apr 26, 2021
  • Author: Brian S Kim, MD, MTR, FAAD; Chief Editor: William D James, MD  more...
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Immunomodulators are for treatment of patients with severe disease in whom conventional therapy is ineffective. In more severe cases and particularly in adults, consider using both MTX and cyclosporine. The latter is more efficacious, but lesions recur when it is stopped.

Cyclosporine (Neoral, Sandimmune)

Cyclosporine has been demonstrated to be helpful in a variety of skin disorders, especially psoriasis. It acts by inhibiting T-cell production of cytokines and ILs. Like tacrolimus and pimecrolimus (ascomycin), cyclosporine binds to macrophilin and then inhibits calcineurin, a calcium-dependent enzyme, which, in turn, inhibits phosphorylation of nuclear factor of activated T cells and inhibits transcription of cytokines, particularly IL-4. Discontinue treatment if no response occurs within 6 weeks.

Methotrexate (Folex PFS, Rheumatrex)

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction. Satisfactory response is seen 3-6 weeks following administration. Adjust the dose gradually to attain a satisfactory response.

Tacrolimus (Protopic) ointment 0.03% or 0.1%

Tacrolimus is an immunomodulator that suppresses humoral immunity (T-lymphocyte) activity. It is used for refractory disease.

Azathioprine (Azasan, Imuran)

Azathioprine is an imidazolyl derivative of mercaptopurine. It works by blocking the pathway for purine synthesis. The 6-thioguanine nucleotide metabolites mediate most of azathioprine’s immunosuppressive and toxic effects.

Mycophenolate (CellCept, MMF, Myfortic)

Mycophenolate mofetil is an inhibitor of inosine monophosphate dehydrogenase (IMPDH), which blocks de novo guanosine nucleotide synthesis. T and B cells are dependent on this pathway for proliferation.

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