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Dermatological Disorders

CNIs are also effective in treating a number of dermatological disorders that are mediated by the cellular components of the adaptive immune system. Systemically administered ciclosporin has been used in the treatment of psoriasis (Ruzicka 1996) and atopic dermatitis (Sowden et al. 1991). However, long-term use is limited by nephrotoxicity. Systemically administered tacro-limus is effective in the treatment of psoriasis with a similar risk of nephro-toxicity (Jegasothy et al. 1992; The European FK 506 Multicentre Psoriasis Study Group 1996).

Tacrolimus and an analogue, pimecrolimus, penetrate the skin and are available as topical formulations (Marsland and Griffiths 2002; Reynolds and Al-Daraji 2002). Topical tacrolimus is effective in the treatment of atopic eczema (Nghiem et al. 2002), but is not effective in chronic plaque psoriasis (Zonneveld et al. 1998), possibly as a result of insufficient skin penetration. The systemic absorption of topically administered tacrolimus or pime-crolimus is low and the levels observed are considerably lower than those used in transplantation.

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