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Topical tacrolimus 0.03% for the treatment of ocular psoriasis
Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular
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Rodríguez-Ausín, D. Antolín-Garcia, M. Ruano del Salado, C. Hita-Antón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Rodríguez-Ausín" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Antolín-Garcia" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ruano del Salado" ] 3 => array:2 [ "nombre" => "C." 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"apellidos" => "Abreu-González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669116001222" "doi" => "10.1016/j.oftal.2016.02.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116001222?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357941630069X?idApp=UINPBA00004N" "url" => "/21735794/0000009100000010/v1_201609240012/S217357941630069X/v1_201609240012/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579416300834" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.06.009" "estado" => "S300" "fechaPublicacion" => "2016-10-01" "aid" => "1025" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2016;91:501-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 266 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 200 "PDF" => 53 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Variations in the technique for autologous limbal transplantation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "501" "paginaFinal" => "504" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Variaciones en la técnica del trasplante limbar autólogo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 622 "Ancho" => 1400 "Tamanyo" => 156450 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Persistent limbar insufficiency after the first heterologous limbar transplant. (A) 360° neovascularization with thin and uneven epithelium covering the corneal surface in the upper temporal quadrant and conjunctivalization of the rest of the surface. (B) Late fluorescein staining.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Mataix, A. Alcántara, M. Caro, J. Montero, B. Ponte, E. Rodríguez de la Rúa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Mataix" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Alcántara" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Caro" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Montero" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Ponte" ] 5 => array:2 [ "nombre" => "E." 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Rodríguez-Ausín, D. Antolín-Garcia, M. Ruano del Salado, C. Hita-Antón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Rodríguez-Ausín" "email" => array:1 [ 0 => "pazrausin@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Antolín-Garcia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Ruano del Salado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Hita-Antón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 758 "Ancho" => 900 "Tamanyo" => 79073 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chronic corneal involvement with a nasal pseudo-pterygium over stromal thinning and leukomae.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a relatively frequent inflammatory skin disease, affecting up to 2% of the population and diminishing quality of life in 80% de patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Ocular psoriasis rates are not precisely determined but range between 10 and 67% according to different authors.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> A series of 4 patients with ocular psoriasis is presented, who experienced quality of life improvement after beginning treatment with 0.03% topical tacrolimus.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case reports</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Patients</span><p id="par0010" class="elsevierStylePara elsevierViewall">Four patients, 2 males and 2 females, with a mean age of 72<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.82 years, with psoriasis since youth and experiencing pruritus and chronic ocular discomfort. All four exhibited mixed blepharitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and inferior keratitis <span class="elsevierStyleItalic">punctata</span>, while 3 had circumferential pseudopterygium (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and corneal opacities. In one of the patients (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), the right eye (RE) exhibited severe thinning and topographic signs of secondary ectasia. Palpebral hygiene measures for blepharitis and oral doxycycline were insufficient, with a patient experiencing relapse after suspending said treatment. Topical 0.5% cyclosporine in oily carrier (middle chain triglycerids) was applied although intolerance arose in all cases. After obtaining the authorization of the pharmacy committee of the hospital and requesting the patient to sign an informed consent, off label utilization of 0.03% topical tacrolimus was prescribed in a preparation with vaseline, supplied by the hospital pharmacy. The prescription established 2 daily applications for the first 15 days, followed by an indefinite single nocturnal maintenance application. Subjective improvement appeared in 2 weeks, and after one month pruritus and keratitis diminished, while lacrimal film stabilized. In one case, keratitis disappeared at month 3. Gradual reduction of applications up to one weekly application at 6 months follow-up was considered. Follow-up ranged between 3 months and 3 years, without adverse effects. All patients referred substantial changes in their quality of life and none required systemic treatment for psoriasis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic disease, the elementary lesion of which is a scale-covered erithematous papula with highly variable clinic and evolution. Ocular symptoms as frequently underestimated in psoriasis patients, with doctors or patients failing to appreciate the possible connection with the base disease. Extracutaneous expressions are infrequent although, due to the epithelial nature of psoriasis, ocular involvement must be considered in addition to the possible existence of psoriasis plaque on the skin of the eyelids.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In a review on ocular psoriasis, Rehal et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> described mixed blepharitis as the most prevalent ocular finding, with burning and itching as the most frequent symptoms. Psoriasis tends to respect the face and therefore the appearance of facial lesions is considered a severity marker. Psoriasis plaque rarely appears on the eyelids and is treated on the basis of corticoids and equivalent medications such as tacrolimus. Nonspecific chronic conjunctivitis and/or yellow-reddish plaque can appear on the palpebral conjunctiva and in addition 18% of patients suffer dry eye due to lacrimal gland involvement as in other selfimmune systemic diseases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Corneal disease is very rare, normally secondary to dry eye and trichiasis. The most common finding is keratitis <span class="elsevierStyleItalic">punctata</span>, although the clinic range comprises opacities, sterile infiltrates, neovascularization, cicatrization and severe peripheral ulcerative keratitis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Additional ocular involvement of psoriasis includes anterior uveitis and Birdshot chorioretinopathy. The side effects of psoriasis treatments cannot be dismissed, such as isotretinoin and methotrexate, with possible involvement of the ocular posterior pole by the former (neuropathy, maculopathy) and keratitis and dry eye by the latter. Doxycycline should not be utilized simultaneously with isotretinoin as it increases its neurological toxicity.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The 4 patients of the series have chronic blepharitis, 3 with a significant corneal involvement that indicates chronicity such as circumferential pseudopterygium. The main symptom is ocular and palpebral pruritus, which improves slightly with palpebral hygiene, heat and massage and more with oral doxycycline and corticoids. Relapse upon suspension of this treatment indicates an efficient anti-inflammatory therapy with less side effects than corticoids.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Tacrolimus, Protopic<span class="elsevierStyleSup">®</span> (Astellas Pharma, Pozuelo de Alarcón, Madrid, Spain), is a calcineurin inhibitor generally used at 0.03% for atopic dermatitis. The presence of excipients (propylene carbonate) in the skin cream gives rise to doubts about ocular surface toxicity although literature references report goods tolerance in anterior segment diseases refractory to corticoid treatment.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4–6</span></a> To date, local or systemic side effects attributable to the use of tacrolimus on the ocular surface have not published. By way of conclusion, 0.03% topical tacrolimus could be an efficient and well tolerated therapeutic option for ocular psoriasis when it has a negative repercussion on the quality of life of patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interests</span><p id="par0040" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres733573" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective/methods" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Results/conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec737397" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres733572" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objetivo/método" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Resultados/conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec737398" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinic case reports" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-07" "fechaAceptado" => "2016-03-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec737397" "palabras" => array:5 [ 0 => "Tacrolimus" 1 => "Ocular psoriasis" 2 => "Psoriasis" 3 => "Blepharitis" 4 => "Pseudopterygium" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec737398" "palabras" => array:5 [ 0 => "Tacrolimus" 1 => "Psoriasis ocular" 2 => "Psoriasis" 3 => "Blefaritis" 4 => "Seudopterigión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective/methods</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results/conclusions</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective/methods" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Results/conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Objetivo/método</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presentamos una serie de 4 pacientes afectos de psoriasis ocular con sintomatología severa, a los que se indicó tratamiento <span class="elsevierStyleItalic">off label</span> con tacrolimus tópico al 0,03% una vez al día.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Resultados/conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La blefaritis mixta y queratitis es común a los 4, y en 3 casos hay seudopterigión y opacidades corneales. Se apreció mejoría subjetiva del prurito en 2 semanas, y al mes mejoría de la superficie. Todos manifiestan mejoría significativa de su calidad de vida tras un rango de seguimiento de 6 meses a 2 años. El tacrolimus tópico puede ser considerado una opción en el tratamiento de la psoriasis ocular.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Objetivo/método" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Resultados/conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Ausín P, Antolín-Garcia D, Ruano del Salado M, Hita-Antón C. Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular. Arch Soc Esp Oftalmol. 2016;91:505–507.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 672 "Ancho" => 900 "Tamanyo" => 83967 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mixed blepharitis, the most frequent finding in psoriasis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 716 "Ancho" => 851 "Tamanyo" => 59905 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Circumferential pseudo-pterygium with small vessels and whitish line parallel to the limbus.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 758 "Ancho" => 900 "Tamanyo" => 79073 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chronic corneal involvement with a nasal pseudo-pterygium over stromal thinning and leukomae.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.B. 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