Skip to main content
Top
Gepubliceerd in: Bijblijven 2/2007

01-02-2007 | Artikel

De plaats van tacrolimus en pimecrolimus in de behandeling van constitutioneel eczeem

Auteurs: Dr. A. C. de Groot, Dr. R. A. Tupker

Gepubliceerd in: Bijblijven | Uitgave 2/2007

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Samenvatting

De standaardbehandeling van constitutioneel eczeem bestaat uit de dagelijkse applicatie van indifferente middelen en de tijdelijke toepassing van corticosteroïdzalven bij opvlamming van het eczeem. Sinds enkele jaren zijn de calcineurineremmers tacrolimus en pimecrolimus beschikbaar gekomen. Tacrolimus is effectiever dan klasse-1-corticosteroïden en minstens zo effectief als klasse-2-preparaten. Pimecrolimus is minder werkzaam.
De meest voorkomende bijwerkingen zijn branderigheid op de applicatieplaats en irritatie van de huid. Wel is er enige zorg over een mogelijk toegenomen risico op het ontstaan van maligniteiten.
De calcineurineremmers mogen nooit als eerste behandeling worden ingezet. Hun toepassing is beperkt tot volwassenen en kinderen ouder dan 2 jaar die onvoldoende hebben gereageerd op corticosteroïden, die daar bijwerkingen van hebben ondervonden of die afhankelijk zijn van dagelijks gebruik van corticosteroïden over een lange periode. Langdurig gebruik moet worden vermeden. Tacrolimus verdient de voorkeur boven pimecrolimus.
Literatuur
1.
go back to reference Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142:931-6. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142:931-6.
2.
go back to reference Novak N, Kwiek B, Bieber T. The mode of topical immunomodulators in the immunological network of atopic dermatitis. Clin Exp Dermatol 2005;30:160-4. Novak N, Kwiek B, Bieber T. The mode of topical immunomodulators in the immunological network of atopic dermatitis. Clin Exp Dermatol 2005;30:160-4.
4.
go back to reference Ashcroft DM, Dimmock P, Garside R, Stein K, Williams HC. Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: Meta-analysis of randomised controlled trials. BMJ 2005;330:516-24. Ashcroft DM, Dimmock P, Garside R, Stein K, Williams HC. Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: Meta-analysis of randomised controlled trials. BMJ 2005;330:516-24.
5.
go back to reference Paller AS, Lebwohl M, Fleischer AB Jr, Antaya R, Lamgley RG, Kirsner RS, et al. Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: Results from 3 randomized, comparative studies. J Am Acad Dermatol 2005;52:810-22. Paller AS, Lebwohl M, Fleischer AB Jr, Antaya R, Lamgley RG, Kirsner RS, et al. Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: Results from 3 randomized, comparative studies. J Am Acad Dermatol 2005;52:810-22.
6.
go back to reference Reitamo S, Harper J, Bos JD, Cambazard F, Bruijnzeel-Koomen C, Valk P van der, et al. 0.03% Tacrolimus ointment applied once or twice daily is more efficacious than 1% hydrocortisone acetate in children with moderate to severe atopic dermatitis: results of a randomized double-blind controlled trial. Br J Dermatol 2004;150:554-62. Reitamo S, Harper J, Bos JD, Cambazard F, Bruijnzeel-Koomen C, Valk P van der, et al. 0.03% Tacrolimus ointment applied once or twice daily is more efficacious than 1% hydrocortisone acetate in children with moderate to severe atopic dermatitis: results of a randomized double-blind controlled trial. Br J Dermatol 2004;150:554-62.
7.
go back to reference Nakagawa H. Comparison of the efficacy and safety of 0.1% tacrolimus ointment with topical corticosteroids in adult patients with atopic dermatitis: Review of randomised, double-blind clinical studies conducted in Japan. Clin Drug Invest 2006;26:235-46. Nakagawa H. Comparison of the efficacy and safety of 0.1% tacrolimus ointment with topical corticosteroids in adult patients with atopic dermatitis: Review of randomised, double-blind clinical studies conducted in Japan. Clin Drug Invest 2006;26:235-46.
8.
go back to reference Reitamo S, Ortonne JP, Sand C, Cambazard F, Bieber T, Folster-Holst R, et al. A multicentre, randomized, double blind, controlled study of long-term treatment with 0.1% tacrolimus ointment in adults with moderate to severe atopic dermatitis. Br J Dermatol 2005;152:1282-9. Reitamo S, Ortonne JP, Sand C, Cambazard F, Bieber T, Folster-Holst R, et al. A multicentre, randomized, double blind, controlled study of long-term treatment with 0.1% tacrolimus ointment in adults with moderate to severe atopic dermatitis. Br J Dermatol 2005;152:1282-9.
10.
go back to reference Fonacier L, Spergel J, Charlesworth EN, Weldon D, Beltrani V, Bernhisel-Broadbent J, et al. Report of the Topical Calcineurin Inhibitor Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol 2005;115:1249-53. Fonacier L, Spergel J, Charlesworth EN, Weldon D, Beltrani V, Bernhisel-Broadbent J, et al. Report of the Topical Calcineurin Inhibitor Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol 2005;115:1249-53.
11.
go back to reference Berger TG, Duvic M, Voorhees AS Van, VanBeek MJ, Frieden IJ; American Academy of Dermatology Association Task Force. The use of topical calcineurin inhibitors in dermatology: Safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol 2006;54:818-23. Berger TG, Duvic M, Voorhees AS Van, VanBeek MJ, Frieden IJ; American Academy of Dermatology Association Task Force. The use of topical calcineurin inhibitors in dermatology: Safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol 2006;54:818-23.
12.
go back to reference Ormerod AD. Topical tacrolimus and pimecrolimus and the risk of cancer: How much cause for concern? Br J Dermatol 2005;153:701-5. Ormerod AD. Topical tacrolimus and pimecrolimus and the risk of cancer: How much cause for concern? Br J Dermatol 2005;153:701-5.
13.
go back to reference Qureshi AA, Fischer MA. Topical calcineurin inhibitors for atopic dermatitis: Balancing clinical benefit and possible risks. Arch Dermatol 2006;142:633-7. Qureshi AA, Fischer MA. Topical calcineurin inhibitors for atopic dermatitis: Balancing clinical benefit and possible risks. Arch Dermatol 2006;142:633-7.
14.
go back to reference Draelos Z, Nayak A, Pariser D, Shupack JL, Chon K, Abrams B, et al. Pharmacokinetics of topical calcineurin inhibitors in adult atopic dermatitis: A randomized, investigator-blind comparison. J Am Acad Dermatol 2005;53:602-9. Draelos Z, Nayak A, Pariser D, Shupack JL, Chon K, Abrams B, et al. Pharmacokinetics of topical calcineurin inhibitors in adult atopic dermatitis: A randomized, investigator-blind comparison. J Am Acad Dermatol 2005;53:602-9.
15.
go back to reference Harper J, Green A, Scott G, Gruendl E, Dorobek B, Cardno M, et al. First experience of topical SDZ ASM 981 in children with atopic dermatitis. Br J Dermatol 2001;144:781-7. Harper J, Green A, Scott G, Gruendl E, Dorobek B, Cardno M, et al. First experience of topical SDZ ASM 981 in children with atopic dermatitis. Br J Dermatol 2001;144:781-7.
16.
go back to reference Arellano FM, Wentworth CE, Arana A, Fernandez C, Paul CF. Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis. J Invest Dermatol 9 november 2006 (Epub ahead of print). Arellano FM, Wentworth CE, Arana A, Fernandez C, Paul CF. Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis. J Invest Dermatol 9 november 2006 (Epub ahead of print).
17.
go back to reference Paul CF, Ho VC, McGeown C, Christophers E, Schmidtmann B, Guillaume JC, et al. Risk of malignancies in psoriasis patients treated with cyclosporine: A 5 y cohort study. J Invest Dermatol 2003;120:211-6. Paul CF, Ho VC, McGeown C, Christophers E, Schmidtmann B, Guillaume JC, et al. Risk of malignancies in psoriasis patients treated with cyclosporine: A 5 y cohort study. J Invest Dermatol 2003;120:211-6.
18.
go back to reference Hon KL, Kam WY, Leung TF, Lam MC, Wong KY, Lee KC, et al. Steroid fears in children with eczema. Acta Paediatr 2006;95:1451-5. Hon KL, Kam WY, Leung TF, Lam MC, Wong KY, Lee KC, et al. Steroid fears in children with eczema. Acta Paediatr 2006;95:1451-5.
20.
go back to reference Bigby M. Tacrolimus and pimecrolimus for atopic dermatitis: Where do they fit in? Arch Dermatol 2006;142:1203-5. Bigby M. Tacrolimus and pimecrolimus for atopic dermatitis: Where do they fit in? Arch Dermatol 2006;142:1203-5.
Metagegevens
Titel
De plaats van tacrolimus en pimecrolimus in de behandeling van constitutioneel eczeem
Auteurs
Dr. A. C. de Groot
Dr. R. A. Tupker
Publicatiedatum
01-02-2007
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Bijblijven / Uitgave 2/2007
Print ISSN: 0168-9428
Elektronisch ISSN: 1876-4916
DOI
https://doi.org/10.1007/BF03087545

Andere artikelen Uitgave 2/2007

Bijblijven 2/2007 Naar de uitgave