Cyclosporine is not appropriate for long-term use in nail psoriasis due to its associated nephrotoxicity. Learn more about Psoriasis: Recommendations for cyclosporine at aad.org. CSA’s most serious side effects are nephrotoxicity and hypertension. 80 Although reversible changes in the kidney may be related to this vascular effect, long-term therapy frequently leads to permanent scarring with subsequent loss of renal function. Some of the side effects that can occur with cyclosporine may not need medical attention. The mechanism of cyclosporine-induced nephrotoxicity is now considered to be vasoconstriction of the afferent arterioles. The permanent blindness which was reported in one patient was suspected to be due to neurotoxicity associated with elevated cyclosporine levels. Dubertret L Long-term safety of cyclosporine in the treatment of psoriasis.
2,7 While the long-term prognosis has not been established, one study concluded that one-third of individuals with guttate psoriasis develop classic plaque disease within 10 years. This drug has been used in the treatment of psoriasis for over 80 years, but due to its staining properties, it is not a cosmetically acceptable agent. The use of cyclosporine is associated with hypertension and nephrotoxicity requiring the addition of an antihypertensive or a calcium channel blocker or a reduction of the dosage. Methotrexate, cyclosporin, acitretin and narrow-band ultraviolet B phototherapy help most patients. This necessitates careful consideration as to the short-, medium- and long-term risks of psoriasis, its comorbidities and its treatments. Cyclosporin has been used in pregnancy when severe psoriasis has not responded to other therapies. Three different forms of cyclosporine nephrotoxicity can be distinguished: reversible acute renal dysfunction, hemolytic-uremic like syndrome and irreversible chronic nephrotoxicity. Although the risk-benefit ratio of CsA therapy in transplantation medicine is clearly in favor of its use, it is questionable whether this is also the case for all forms of auto-immune diseases. There is less unanimity with regard to the long-term nephrotoxic effect of low-dose regimens used in auto-immune diseases. The present meta-analysis is based on an a priori defined methodology, and is linked with a review of CsA-induced morphological lesions in order to draw relevant conclusions with regard to CsA-induced nephrotoxicity.
Psoriasis is a common papulosquamous skin disease that may be associated with a seronegative spondyloarthropathy. Psoriasis patients are not only more likely to have CV risk factors but severe psoriasis may serve as an independent risk factor for CV mortality. Although more effective toward long term remission of psoriasis, psoralen plus UVA (PUVA) therapy is less utilized given increased risk of melanoma and non-melanoma skin cancers. Shampoos may be used for psoriasis on the scalp but limited contact time limits efficacy, making solutions and sprays more effective for the scalp. A Cochrane review published in 2011 showed that the compounded vitamin D analog calcipotriene and betamethasone dipropionate was more effective for long-term treatment of mild to moderate psoriasis than using either drug alone. 70 Once a patient begins taking a biologic drug, its important to closely follow them for drug-related adverse events. Treating patients for more than 1 to 2 years without nephrology consultation is not recommended because of CsA-associated risk of nephrotoxicity. TREATMENT OF PSORIASIS Topical therapy Phototherapy Systemic therapy Climatotherapy. The efficacy of calcipotriene is not reduced with long-term treatment. It is often used in combination with or in rotation with topical corticosteroids in an effort to maximize therapeutic effectiveness while minimizing steroid-related skin atrophy.
Salicylic acid should not be mixed with vitamin D3 analogues due to. The development of FAE as psoriasis treatment did not follow the traditional drug development phases. FAE are currently one of the most commonly used treatments in Germany, and FAE are increasingly being used as an unlicensed treatment in several other European countries. The long-term safety profile of continuous FAE treatment is favorable without an increased risk for infections, malignancies, or other serious adverse events. These adverse events could possibly be related to FAE-induced lymphocytopenia. Findings may be used for research purposes, but should not be considered current. Among several clinical psoriasis phenotypes, chronic plaque psoriasis is the most frequent, accounting for all but 10 percent of cases. Nonbiologic systemic therapies may be effective but can be associated with significant short-term and long-term adverse events (hepatotoxicity, nephrotoxicity, hypertension, dyslipidemia, malignancy, and teratogenicity). Due to the increase in bioavailability of cyclosporine following conversion to Neoral, the cyclosporine blood trough concentration may exceed the target range. Current assay results are also not interchangeable and their use should be guided by their approved labeling. Care should be taken in using cyclosporine with nephrotoxic drugs. Therefore, it is not appropriate as maintenance therapy. Systemic treatments used to treat psoriasis are summarized in Table 5.
The most troublesome side-effects of CyA are nephrotoxicity and hypertension, both of which are of particular concern in long-term use. This combination was associated with significant clinical improvement and did not increase its toxicity.