Guidelines Summary

Guidelines on diagnosis and assessment, topical therapy, phototherapy and systemic agents, and disease flares and adjunctive therapy are available from the American Academy of Dermatology at Atopic dermatitis clinical guideline.^[76]

Guidelines on the safe and effective prescribing of oral cyclosporine in dermatology by the British Association of Dermatologists ^[77]

Cyclosporine is licensed for use in the following indications:

Atopic dermatitis (in persons aged 16 years or older)
Psoriasis (in persons aged 16 years or older)

Good evidence supports the use of cyclosporine outside its product license for the following indications:

Atopic dermatitis (in persons younger than 16 years)
Behçet disease
Chronic spontaneous (idiopathic) urticaria
Graft versus host disease
Palmoplantar pustulosis
Pyoderma gangrenosum

Cyclosporine should be used only as a last resort in the following indications, and current evidence shows it is unlikely to be beneficial:

Alopecia areata
Discoid lupus erythematosus
Pemphigus foliaceous
Pemphigus vulgaris

Continuous treatment may be considered for select patients with chronic skin disease in the appropriate situation; however, in an effort to reduce nephrotoxicity, use single or intermittent short courses of up to 16 weeks if possible. Cyclosporine dose titration during therapy also should be used to reduce nephrotoxicity.

If hypertension occurs, the cyclosporine dose should be reduced and/or the hypertension should be treated. If appropriate blood pressure cannot be maintained, discontinue cyclosporine.

If infection is suspected, consider obtaining consult on the safety of inducing immunosuppression; ensure all necessary treatment is being administered before beginning cyclosporine.

Patients should be advised to seek advice early if febrile illness occurs or their skin condition rapidly worsens.

Owing to a long‐term risk of developing nonmelanoma skin cancer, cyclosporine should not be administered concurrently with phototherapy.

Serum lipid levels should be measured for a baseline and should be monitored throughout treatment; this is especially important in patients considered high risk (eg, diabetics, those with preexisting hyperlipidemia).

Medication

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Media Gallery

Atopic dermatitis. Typical atopic dermatitis on the face of an infant.
Atopic dermatitis. Flexural involvement in childhood atopic dermatitis.
Atopic dermatitis. Dirty neck sign in chronic atopic dermatitis.
Atopic dermatitis. Irritation around mouth of an infant with atopic dermatitis.

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Author

Brian S Kim, MD, MTR, FAAD Sol and Clara Kest Professor, Vice Chair of Research, Site Chair, Mount Sinai West and Morningside, Director, Mark Lebwohl Center for Neuroinflammation and Sensation, The Kimberly and Eric J Waldman Department of Dermatology, Precision Immunology Institute, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai

Brian S Kim, MD, MTR, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Society for Investigative Dermatology

Disclosure: Received research grant from: Doris Duke Charitable Foundation, Celgene Corporation, LEO Pharma, and the National Institute of Arthritis Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health [NIH (K08AR065577 and R01AR070116)]<br/>Consultant for AbbVie, AstraZeneca, Cara Therapeutics, Galderma, GlaxoSmithKline, Pfizer, Regeneron, Sanofi Genzyme, Trevi Therapeutics; Scientific Advisory Board for Abrax Japan, Granular Therapeutics, and Recens Medical. .

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Acknowledgements

Peter Fritsch, MD Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Bernice R Krafchik, MBChB, FRCPC Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.