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

Updated: Mar 27, 2020
  • Author: Scott L Flugman, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Topical Immunomodulators

These agents modify immune processes that promote inflammation.

Pimecrolimus (Elidel cream)

Pimecrolimus is indicated for eczema and atopic dermatitis. It was the first nonsteroid cream approved in the United States for mild-to-moderate atopic dermatitis. Pimecrolimus is derived from ascomycin, a natural substance produced by fungus Streptomyces hygroscopicus var ascomyceticus.

This agent selectively inhibits production and release of inflammatory cytokines from activated T cells by binding to cytosolic immunophilin receptor macrophilin-12. The resulting complex inhibits phosphatase calcineurin, thus blocking T-cell activation and cytokine release.

Cutaneous atrophy was not observed in clinical trials, a potential advantage over topical corticosteroids.

Tacrolimus ointment (Protopic) 0.1% or 0.03%

Tacrolimus reduces itching and inflammation by suppressing release of cytokines from T cells. It also inhibits transcription for genes that encode interleukin (IL)–3, IL-4, IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor–alpha (TNF-alpha), all of which are involved in the early stages of T-cell activation.

Additionally, tacrolimus may inhibit release of preformed mediators from skin mast cells and basophils and may down-regulate expression of the high-affinity IgE receptor (FCeRI) on Langerhans cells.

Tacrolimus can be used in patients as young as 2 years. It is more expensive than topical corticosteroids. This agent is available as ointment in concentrations of 0.03% and 0.1%.


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