Indian Journal of Dermatology
CORRESPONDENCE COLUMN
Year
: 2006  |  Volume : 51  |  Issue : 1  |  Page : 66--67

Tacrolimus ointment in the treatment of atopic hand eczema


Joseph Shri, Boaz Amichai 
 Dept. of Dermatology; Tel-nordoy Clinic of Clalit Health Services, 1 Dov Hoz St. Tel Aviv, Israel

Correspondence Address:
Joseph Shri
Dept. of Dermatology; Tel-nordoy Clinic of Clalit Health Services, 1 Dov Hoz St. Tel Aviv
Israel




How to cite this article:
Shri J, Amichai B. Tacrolimus ointment in the treatment of atopic hand eczema.Indian J Dermatol 2006;51:66-67


How to cite this URL:
Shri J, Amichai B. Tacrolimus ointment in the treatment of atopic hand eczema. Indian J Dermatol [serial online] 2006 [cited 2022 Jan 26 ];51:66-67
Available from: https://www.e-ijd.org/text.asp?2006/51/1/66/25212


Full Text

Atopic hand eczema (AHE) is a form of atopic dermatitis, it is a chronic relapsing skin disorder that presents with erythema, edema, itching and fissures, located to fingers and dorsum of hands. It is most frequently treated with topical steroids and emollients.[1]

Tacro;imus ointment (Protopicβ, Fujisawa, Japan) is a new immunmodulator, which has been found to be effective and safe in the treatment of atopic dermatitis. [2],[3],[4] This pilot study was initiated to evaluate the efficacy of Protopicβ 0.1% ointment in the treatment of AHE.

This study was an open-label noncomparative study using Protopicβ 0.1% ointment in patients with AHE. A total of 10 patients, 7 women and 3 men aged 23-48 years, were enrolled into the study. Duration of the skin disease ranged from 10 months to 5 years. Inclusion criteria included patients with hand eczema, known history of atopy; atopic dermatitis, hay fever or asthma. Other possible causes for hand eczema like contact dermatitis or psoriasis were ruled-out. Patients had to stop topical application of steroids and systemic use of steroids or antihistamines 4 weeks before entering the study. After the first screening patients applied Proropicβ 0.1% ointment twice daily for 4 weeks. Evaluation was made before treatment after 4 weeks of treatment and after a follow-up period of 4 weeks. During the follow-up treatment patients used emollients. Assessment of treatment efficacy was established at each visit based on these parameters: itch (and/or burning sensation), dryness, erythema, lichenification, erosions and fissures, suing a score of 0-3 (0=none, 1=mild, 2=moderate, 3=severe) for each of the signs and symptoms. The global investigator score was based on the assessment of the total score. We determine severity index of the disease by using the total score. Patients with total score of 4-6 mild disease, 7-11 moderate and more then 12 severe. The score of 0-3 determinate marked or complete improvement.

Of ten patients who entered the study 4 patients had marked or complete improvement at the end of treatment, in 4 cases partial improvement was found while in one patient treatment failed. One patient left the study due to side effects. During the follow-up period most of the patients did not experience significant relapse. Patients noted that itching and burning sensation were the first symptom to resolve during the first days of treatment. The investigator global score before, after the treatment and at the end of the follow-up is seen in [Table 1]. One patient left the study because of local side effects. He complained of severe irritation caused by application of Protopicβ ointment.

The incidence of atopic hand eczema in patients with atopic background, differs greatly in published reports and range from 22-49%. It is well known that patients suffered from atopic dermatitis during childhood, if still affected as adults, frequently, have their eczema localized to hands.[1]

Although it is quite common it is less recognized among dermatologists. AHE may involve the dorsal or the palmar parts of the hands. The most common type of AHE involves the dorsal aspects of the hands and is characterized by dryness, mild erythema, lichenification, itching, erosions and fissures. Nummular lesions present another type of dorsal AHE. Two forms of palmar AHE are also known; the vesicular type, which characterized by vesicular eruption of the palms-pompholyx form and the dry lichenified form.[1]

ProtopicR ointment is known to be both effective and safe in the treatment of atopic dermatitis in children and adults. [2],[3],[4] Yet, as far as we know, there is no specific study in which tacrolimus ointment was used in the treatment of ADE. In other forms of hand eczema tacrolimus ointment was found to be effective; Schnopp et al.[5] compared the efficacy of tacrolimus 0.1% and mometasone furoate 0.1% ointments in patients with chronic palmar dyshidrotic eczema and found similar results.

The results of out study suggest that tacrolimus could be an alternative effective treatment to topical steroids in the treatment AHE.

References

1Moller H, Atopic Hand Eczema. In: Hand Eczema. Menne T, Maibach HI (eds). 2nd Ed. CRC Press LLC, Florida, 2000. Pp 141-5.
2Paller A, Eichenfield LF, Leung DY, Stewart D, Appell M. A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001;44(suppl):S-47-57.
3Hanifin JM, Ling MR, langley R, Breneman D, Rafal E. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: Part I, efficacy. J Am Acad Dermatol 2001;44(suppl): S28-38.
4Reitamo S, Rustin M, Ruzicka T, Cambazard F, Kalimo K, Friedmann PS, et al . Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immunol 2002; 109:547-55.
5Schnopp C, Remling R, Mohrenschlager M, Weigl L, Ring J et al . Topical tacrolimus (FK506) and mometasone furoate in treatment of dyshidrotic palmar eczema: A randomized, observer-blind trial. J Am Acad Dermatol 2002; 46:73-7.