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Increased topical tacrolimus absorption in generalized leukemic erythroderma.
Daisuke Teshima1, Hiroaki Ikesue, Yoshinori Itoh
1Department of Pharmacy, Kyushu University Hospital, Maidashi, Fukuoka, Japan. dteshima@st.hosp.kyushu-u.ac.jp
The Annals of Pharmacotherapy
|October 2, 2003
Summary
Topical tacrolimus absorption increased significantly with larger application areas in an erythrodermic patient. Careful monitoring of blood tacrolimus levels and dose adjustment is crucial, especially in generalized erythroderma.
Area of Science:
- Dermatology
- Clinical Pharmacology
- Immunosuppression
Background:
- Generalized erythroderma, a severe skin condition, often presents challenges in treatment.
- Human T-cell lymphotropic virus (HTLV) infection can lead to erythroderma and significant itching.
- Standard treatments like potent glucocorticosteroids may be insufficient for severe erythroderma.
Observation:
- A patient with HTLV-associated generalized erythroderma received topical tacrolimus 0.1% ointment.
- Application area and dose of tacrolimus were progressively increased, leading to a rise in blood tacrolimus concentrations.
- Despite dose reduction, blood tacrolimus levels remained elevated until the application area was significantly reduced.
Findings:
- Topical tacrolimus absorption is substantial, particularly when applied over large body surface areas.
- Increased blood tacrolimus concentrations appear to correlate with a higher percentage of body surface area treated per dose.
- The safety of topical tacrolimus in generalized erythroderma is not fully established.
Implications:
- Therapeutic drug monitoring of blood tacrolimus is essential to prevent potential nephrotoxicity.
- Application area and dosage of topical tacrolimus require careful adjustment in patients with erythroderma.
- Minimizing the application area is recommended for barrier-disrupted skin conditions like erythroderma.