Which medications in the drug class Immune modulators are used in the treatment of Nummular Dermatitis (Nummular Eczema)?

Updated: Aug 16, 2019
  • Author: Jami L Miller, MD; Chief Editor: William D James, MD  more...
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Answer

Immune modulators

Immune modulators reduce inflammation.

Pimecrolimus 1% cream (Elidel)

Pimecrolimus is the first nonsteroid cream approved in the United States for mild-to-moderate atopic dermatitis. It is derived from ascomycin, a natural substance produced by fungus Streptomyces hygroscopicus var ascomyceticus. Pimecrolimus 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. Pimecrolimus is indicated only after other treatment options have failed.

Tacrolimus 0.03% or 0.1% ointment (Protopic)

The mechanism of action of tacrolimus in atopic dermatitis is not known. It reduces itching and inflammation by suppressing the release of cytokines from T cells. It also inhibits transcription for genes that encode IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in the early stages of T-cell activation. Additionally, tacrolimus may inhibit the release of preformed mediators from skin mast cells and basophils, and down-regulate expression of FCeRI on Langerhans cells. It can be used in patients as young as 2 years. Drugs of this class are more expensive than topical corticosteroids. Tacrolimus is available as an ointment in concentrations of 0.03 and 0.1%. It is indicated only after other treatment options have failed.


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