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Published on: November 8, 2015
[Risks of cyclosporine therapy in paediatric age]
João Antunes1, Catarina Gouveia, Maria João Brito
1Serviços de Imunoalergologia, Unidade de Infecciologia, Hospital Dona Estefânia, Lisboa.
Insights
Cyclosporine is effective for pediatric inflammatory skin conditions but carries risks. Careful monitoring is essential due to potential side effects like infections and organ impairment in children.
Area of Science:
- Pediatric Dermatology
- Immunosuppressive Therapy
Background:
- Cyclosporine is recognized for treating inflammatory skin disorders in adults and children.
- Its pediatric application requires further investigation and cautious consideration.
Observation:
- Three pediatric cases (atopic dermatitis and psoriasis) treated with oral cyclosporine are presented.
- Patients experienced adverse events including impetigo, herpetic infection, hepatic, and renal impairment.
Findings:
- Adverse events necessitated treatment cessation in all three pediatric patients.
- Potential drug interactions and cyclosporine toxicity were noted.
- Complications included secondary impetigo, herpetic infections, and organ dysfunction.
Implications:
- Data on cyclosporine use in children remains limited.
- Cyclosporine in pediatric patients should be reserved for specific indications.
- Risk-benefit assessment and vigilant monitoring are crucial for safe utilization.
Introduction:
Cyclosporine has been found to be effective and safe in many inflammatory skin disorders such as psoriasis and atopic dermatitis (AD), in adults and in children. Its use in paediatrics is still under scope. We present three patients who started cyclosporine but stopped due to complications. It is our aim to warn about potential side effects of cyclosporine and recommend cautious utilization.
Clinical Cases:
Two children, aged 4 and 13 years, with AD and one child, aged 2 years, with erythrodermic psoriasis, were treated with oral cyclosporine.
First Case:
developed secondary impetigo on the 6th day of treatment. Started topical corticosteroids and topical calcineurin inhibitors afterwards, with no relapses.
Second Case:
developed herpetic infection, hepatic and renal impairment (eventual drug interaction) on the 4th day of treatment. THIRD CASE: Psoriasis and impetigo, treated with flucloxacillin, gentamicin. Generalized angioedema and urticariform lesions after 6 days of cyclosporine. Beta lactam hypersensitivity reaction under study. Eventual cyclosporine toxicity to consider.
Comments:
The data on cyclosporine use in children is still scarce. Use should be limited to cases with precise indication, after considering risks and benefits.
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