A new alternative in the treatment of hand eczema: topical pimecrolimus

Backgorund and Design: Hand eczema is the most common form of occupational dermatoses. Because of chronic and relapsing course, therapy is a problem for both physician and patient. New treatment alternatives have been investigated because of side effects of long-term topical corticosteroids use. In this study, we aimed to evaluate the efficacy of pimecrolimus 1% cream, an ascomisin derivative successfully used for atopic dermatitis, in the treatment of hand eczema. MATERIAL-METHOD: In this placebo-controlled, randomized study, pimecrolimus 1% cream was applied on one hand and placebo on the other hand of 25 patients twice daily for 8 weeks. Response to the therapy was assessed clinically at 2., 4., 6. and 8. weeks of the therapy. In the clinical assessment, erythema, desquamation, lichenification, edema, vesiculation and fissuring were scored between 0-4. Same scoring system was used also for the pruritus symptom of the patients. Side effects during the therapy were also recorded. The patients were followed for 8 additional weeks after the end of the therapy. RESULTS: Nine male and 15 female patients with ages ranging from 18 to 63 (mean 35.79) completed the study. Of the patients, 14 were housewives, 4 were health workers, 3 were teachers, 1 was policeman, 1 was farmer and 1 was a haberdasher. The duration of disease ranged between 6 months and 20 years (mean 4.9 years). Diagnosis of irritant contact dermatitis was made in 13 patients and allergic contact dermatitis in 11 patients. Pimecrolimus 1% cream was well tolerated in all patients and no side effect was observed. The clinical score of pimecrolimus-applied hand improved significantly when compared with placebo applied hand (p=0.04). CONCLUSION: It is concluded that topical pimecrolimus cream appears to be an effective and easily appliable treatment alternative for all manifestations of hand eczema except for vesiculation, without any rebound and tachyphylaxis.

El ekzemasý tedavisinde yeni bir seçenek: topikal pimekrolimus

AMAÇ: Meslek dermatozlarý arasýnda en sýk görülen tablo el ekzemalarýdýr. El ekzemalarýnýn kronik ve tekrarlayýcý seyrinden dolayý tedavisi hem hasta hem de hekim için sorun teþkil etmektedir. Topikal kortikosteroidlerin uzun süreli kullanýmlarýna baðlý yan etkilerinden dolayý yeni tedavi arayýþlarý doðmuþtur. Bu çalýþmamýzda askomisin türevi olan ve atopik dermatit tedavisinde güvenle kullanýlan topikal pimekrolimus %1 kremin el ekzemasý tedavisindeki etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ-YÖNTEM: Plasebo kontrollü, randomize çalýþmamýzda bilateral el ekzemasý olan toplam 25 hastanýn her bir eline plasebo ve diðer tarafýna pimekrolimus %1 krem uygulatýldý. Çalýþmanýn 2., 4., 6. ve 8. haftalarýnda tedaviye cevap klinik olarak deðerlendirildi. Klinik deðerlendirmede eritem, deskuamasyon, likenifikasyon, ödem, vezikülasyon, fissür oluþumu 0-4 arasýnda skorlandý. Ayrýca hastalarýn kaþýntý deðerlendirmesinde ayný skorlama kullanýldý. Tedavi sýrasýnda görülen yan etkiler de kayýt edildi. Hastalar 8 haftalýk tedavi dönemini takiben yaklaþýk 8 hafta süresince tedavisiz izlendi. BULGULAR: Tedaviyi tamamlayan 9 erkek, 15 kadýn hastanýn yaþlarý 18 - 63 arasýnda (ortalama yaþ 35.79) deðiþiyordu. Meslek gruplarý incelendiðinde 14’ü ev hanýmý, 4’ü saðlýk personeli, 3’ü öðretmen, 1’i polis, 1’i çiftçi ve 1’i tuhafiye malzemeleri imalatçýsý olarak deðiþiyordu. Hastalýk süreleri 6 ay-20 yýl (ortalama 4.9 yýl) arasýnda idi. On üç hastada iritan kontakt dermatit, 11 hastada allerjik kontakt dermatit tanýsý saptandý. Pimekrolimus %1 krem hastalar tarafýndan iyi tolere edilmiþ ve hiçbir yan etki gözlenmemiþtir. Tedavi sonu ilaç uygulanan ele ait toplam klinik skorlar plasebo uygulanan ele ait skorlar ile karþýlaþtýrýldýðýnda anlamlý bir azalma saptanmýþtýr (p=0.04).
SONUÇ: Sonuç olarak el ekzemalarýnýn tedavisinde topikal pimekrolimusun vezikülasyon dýþýndaki tüm belirtileri baskýlamada oldukça etkili, ribaund ve taþiflaksiye neden olmayan, kullanýmý kolay bir tedavi seçeneði olabileceði sonucuna varýlmýþtýr.