Experimental New Topical Therapeutic Agents

Since retinoids have been shown to possess anti-inflammatory and antiproliferative as well as regulatory capacity on keratinocyte differentiation, they are good candidates to be beneficial in LE. In fact, various topical and systemic retinoids have been reported to be effective in patients with subacute CLE (SCLE) and chronic CLE (Werth et al. 1997). However, systematic controlled studies are lacking here too.

Tazarotene, the receptor-selective topical representative of the novel acetylenic retinoids, has been very effective in the treatment of an otherwise untreatable patient with DLE (Edwards et al. 1999). Further studies are needed to evaluate the role of topical retinoids in LE.

Another very promising development in topical dermatotherapy are the calcineurin inhibitors. Tacrolimus and pimecrolimus are prototypes of a class of immunosuppressive agents with a great potential in the treatment of inflammatory skin diseases, atopic dermatitis above all, but also in cutaneous autoimmune diseases. These pharmaceuticals have been shown to act at a point in activation of T lymphocytes that lies between T-cell receptor ligation and the transcription of early genes. Therefore, besides atopic dermatitis, all T-cell-mediated skin diseases, such as lichen planus, represent a potential area of use. Animal studies have demonstrated a beneficial effect of systemic tacrolimus in murine SLE (Furukawa et al. 1995). Similarly, systemic application of tacrolimus was used successfully in patients with SLE whose active disease had been poorly controlled by conventional treatments (Ruzicka et al. 1999). Consequently, topical calcineurin inhibitors were applied to treat the malar rash of SLE,with good results in three patients (Kanekura 2003).Anecdotal reports also demonstrated good efficacy of tacrolimus and pimecrolimus in patients with severe recalcitrant chronic DLE (Furukawa et al. 2002,Walker et al. 2002,Yoshimasu et al. 2002, Zabawski 2002), SCLE (Bohm et al. 2003, Druke et al. 2004), and LE tumidus (Bacman et al. 2003). Taken together, preliminary reports show very promising effects of this highly interesting new generation of topical treatment modality in dermatotherapy for cutaneous autoimmune disease, which urgently needs systematic evidence-based study evaluation.

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