How Do Topical Immunosuppressive Agents Work?

Topicalimmunosuppressiveagents are drugs thatcontrolor suppress theimmune systemand are used to treat inflammatoryskindiseases.

Topical immunosuppressive agents work on both theimmune系统(通过抑制pro-inflammatory cytokines) and the skin cells called “keratinocytes”.

• On the immune system:
  • They bind to areceptorwithin thecellcalled FK bindingproteins.
  • This resultsina drug-proteincomplex that further inhibits calcineurin (acalcium-dependent phosphatase-transmitting chemical)
  • Inhibition of calcineurin, in turn, reduces the activity of T-lymphocytes in the immune system.
  • T-lymphocytes are responsible for killing infectedhost细胞,激活其他方面ne cells, producing cytokines, and regulating theimmune response.
  • As a result, T-cells fail to release cytokines (chemicals that causeinflammation, redness, anditching).
• On the skin cells:
  • They reduce the number of interleukin-8 (IL-8)cytokinereceptors on the skin cells, thus reducing inflammation.
  • IL-8 is produced by various tissues and responsible for attracting and activation of neutrophils (whitebloodcells) at the site of inflammation.

Topical immunosuppressive agents work equally well for both adults and children with more than two-thirds of both groups having an improvement of greater than 50 percent.

Topical immunosuppressive agents should be applied on lesions (a thin layer rubbed in gently) two to three times a day until they subside.

Skin conditions treated with topical immunosuppressive drugs include the following:

• Moderate-to-severeatopic dermatitisin adults and children
  • responding poorly to conventionaltherapy(oralsteroids, antibiotics)
  • suffer from side effects of conventional therapy
• Atopiceczema(an allergic-typeconditionthat causes red, irritated, and itchy skin)
• Psoriasis(a skindiseasethat causes red, itchy scaly patches, most commonly on the knees, elbows, trunk, and scalp)
• Alopecia areata(a condition that causes hair to fall out in small patches)
• Pemphigus(a rare skin disorder characterized by blistering of your skin andmucousmembranes)
• Eosinophilic fasciitis(asyndromein whichtissueunder the skin and over themuscle, calledfascia, becomes swollen, inflamed. and thick)
• Seborrheic dermatitis(scaly patches, red skin, and stubborndandruff)
• Genitallichen sclerosus (an uncommon condition that creates patchy, white skin that appears thinner than normal)
• Orallichen planus(white, lacy patches; red, swollen tissues; or open sores)
• Vitiligo(a disease that causes loss ofskin colorin patches)
• Discoid lupuserythematosus (achronicskin condition of sores with inflammation and scarring)

Avoid using in sensitive areas such as eyes and insidemouth/nose, and if you apply themedicationin those areas,flushwith plenty ofwater.

Common side effects include:

• Burning/and or stinging
• Dryness
• Pruritis (itchy skin)
• Soreness

Other rare side effects include:

• Headache
• Acne
• Folliculitis(hairbumps)
• Stomachupset
• Flu-like symptoms (fever,chills,runny nose,sore throat, and muscle aches)
• Increasedsensitivityof the skin to hot/cold/pain/touch
• Eczema herpeticum (aviral infectioncharacterized by fever and clusters of itchy blisters or punched-out erosions)
• Severedizziness(feeling faint, weak, or unsteady)
• Troublebreathing
• Seriousallergic reaction
  • Rash
  • Hives
  • Itching/swelling of face/tongue/throat

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with yourdoctororpharmacistto make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Drug names include:

• Elidel
• Pimecrolimus
• Protopic
• Tacrolimusointment