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Topical sirolimus in dermatology: a systematic review
Usamah M Afzal1, Mohammad Alazemi2, Omar Ali3
1Harrogate and District Foundation Trust, Harrogate, UK.
Clinical and Experimental Dermatology
|July 17, 2024
Summary
Topical sirolimus shows promise for various dermatological conditions, particularly facial angiofibromas. While generally well-tolerated, evidence quality varies across indications, necessitating further high-quality research.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Topical sirolimus is used off-label for dermatological conditions to avoid systemic side effects.
- Widespread use is hindered by a mixed-quality evidence base.
Approach:
- A comprehensive literature search (2005-2023) was conducted across major databases (MEDLINE, PubMed, Embase, CENTRAL, EBSCO).
- Studies were analyzed for indications, efficacy, safety, concentrations, and cointerventions of topical sirolimus.
Key Points:
- High-quality evidence supports topical sirolimus (0.1%) for facial angiofibromas, especially in tuberous sclerosis.
- Mixed evidence exists for port-wine stains, with potential benefit from combination therapy.
- Case reports suggest efficacy for other vascular abnormalities (1% concentration) and generally favorable outcomes.
Conclusions:
- Topical sirolimus is generally well-tolerated, with localized irritation and pruritus being the most common side effects.
- Ointment formulations and once-daily dosing may improve the side-effect profile.
- While promising for various dermatological applications, the quality of evidence is inconsistent, particularly for less common uses.
