Cyclosporine in dermatology results of a pilot study

Introduction: Cyclosporine (CsA) is a calcineurin inhibitor immunosuppressive. Although highly effective, CsA is not used widely in India because of high cost and fear of serious adverse effects. Paucity of studies on use of CsA in dermatological conditions in India, led to the conduct of this pilot study. Aim: The aim of this study were to determine the efficacy and safety of CsA in various dermatological conditions. Materials and Methods: A total 10 patients of age 8 to 55 years, 4 of lichen planus, 3 of psoriasis (including 1 of psoriatic erythroderma) and 3 of atopic dermatitis were selected for this study. All patients were exhibited 3 to 5 mg/kg/day of oral CsA for a maximum period of 12 weeks. Results: CsA produced an extremely rapid, almost ‘magical’ response; the side effects were minimal and did not warrant withdrawal of the drug. We found a rapid response in psoriasis, the patient of psoriatic erythroderma showed onset of action in 72 hours while the 2 patients of plaque psoriasis showed 75 % reduction in PASI score in 2–3 weeks. All patients of lichen planus showed rapid onset of action in form of decreased/ no fresh lesions in 3 to 4 days. Patients of atopic dermatitis showed 50% reduction in the six areas six sign atopic dermatitis score at end of 4 weeks. The response in atopics was relatively slower requiring higher doses and relapses were encountered on dose reduction. Relapses were seen in all ten cases on discontinuing treatment. In severe cases with frequent history of relapses, relatively safer and cheaper immunosuppressives like methotrexate or azathioprine may be added while tapering the dose of CsA. Careful patient selection and monitoring are required to produce optimum results