Topical tacrolimus therapy for lesions of cutaneous lupus erythematosus - reply to the comments of Drs. Walker, Kirby and Chalmers

European Journal of Dermatology. Volume 12, Number 4, 389, July - August 2002, Lettre de l'éditeur

Author(s) : Fukumi FURUKAWA, Takashi YOSHIMASU, Toshio OHTANI, Koji IKEDA, Takeji NISHIDE, Koji UEDE, Department of Dermatology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan..

ARTICLE

We appreciate the comment of Drs. Walker, Kirby and Chalmers on our recent report on topical tacrolimus. From our experience, this immunosuppressive agent (0.1%) was not effective on chronic discoid lupus erythematosus (CLE) [1]. However, Dr. Walker et al. showed two cases with CCLE which responded very well to topical tacrolimus. The discrepancy seems to be due to the dose of tacrolimus and the synergic effect of tacrolimus and corticosteroid, which is pointed out by them. We also believe that topical tacrolimus is effective for the early lesions of CLE although all cases described in our report belonged to progressed stages. Concerning the effects of topical FK506 on CLE, we have other experimental data on animal models. We previously showed that systemic tacrolimus treatment was very effective for skin lesions and other autoimmune traits of an SLE-prone MRL/Mp-lpr/lpr mouse [2]. The skin lesions are similar to a certain type of discoid lesion of human lupus erythematosus [3]. Tacrolimus (0.1%) was topically applied to the skin lesions of 3-mo-old MRL/lpr mice, and it had therapeutic effects almost equal to the mild class corticosteroid (Fig. 1). Taken together, topical tacrolimus will be a new tool for managing the skin lesions of collagen diseases as well as atopic dermatitis [4].

References

1. Yoshimasu T, Ohtani T, Sakamoto T, Ohshima A, Furukawa. Topical FK506 (tacrolimus) therapy for skin lesions of cutaneous lupus erythematosus and dermatomyositis. Eur J Dermatol 2002; 12: 50-2.

2. Furukawa F, Imamura S, Takigawa M. FK506: therapeutic effects on lupus dermatoses in autoimmune-prone MRL/Mp-lpr/lpr mice. Arch Dermatol Res 1985; 287: 558-63.

3. Furukawa F. Animal models of cutaneous lupus erythematosus and erythematosus photosensitivity. Lupus 1997; 6: 193-202.

4. Ruzicka T, Assmann T, Homey B. Tacrolimus, the drug for the turn of the millennium? Arch Dermatol 1999; 135: 574-80.

Figure 1. Effects of topical tacrolimus on the skin lesions of SLE prone MRL/lpr mice.

The same volume of each agent was applied to the back of at least 4 female MRL/lpr mice (3-mo-old) which had spontaneous LE-like skin lesions, and the changes in the skin lesions were examined every week. Each point represents the ratio of an average of skin score such as erythema, alopecia and induration, in which cutaneous changes at 3-mo-old were estimated as 100%.