Immunosuppressants for Atopic Dermatitis and Psoriasis

Medication issues?

1.
The side effects of ciclosporin may include increased risk of infections, kidney dysfunction, hypertension, gastrointestinal disturbances, and gum hyperplasia.
2.
After discontinuation of ciclosporin, most side effects typically resolve, and organ function may return to baseline health status; however, this can vary depending on the individual and the duration of use.
3.
There is a possibility that the condition may relapse after stopping the medication, as ciclosporin is often used to manage symptoms rather than cure the underlying disease.
Regular monitoring and follow-up with a healthcare provider are recommended.

KTC, 40~49 year old female. Ask Date: 2000/11/15

Dr. Zheng Lizhen reply Dermatology

The most common side effect of cyclosporine is elevated blood pressure, along with its impact on kidney function.
Therefore, prior to initiating cyclosporine treatment, blood pressure and serum creatinine levels are measured as a baseline for future comparisons.
Other less common side effects include increased cholesterol and triglycerides, hirsutism, gingival hyperplasia, tremors, fatigue, and headaches.
Fortunately, most side effects can gradually resolve after dose reduction or discontinuation of the medication.
Once cyclosporine achieves clinical efficacy, the dosage will be gradually reduced.
There is a possibility of relapse after stopping the medication, depending on the individual’s condition.
Therefore, other therapies (such as retinoids, phototherapy, and immunosuppressants) may be used in combination or alternated to minimize side effects while maintaining clinical efficacy.

Reply Date: 2000/11/15

More Info

Immunosuppressants, such as ciclosporin, are commonly used in the treatment of atopic dermatitis and psoriasis, particularly in severe cases where other treatments have failed. While these medications can be effective in managing symptoms and improving skin conditions, they also come with potential side effects and considerations regarding long-term use.

1. Common Side Effects of Ciclosporin:
Ciclosporin is known to have several side effects. The most common include:
- Hypertension: Increased blood pressure is a frequent side effect, necessitating regular monitoring.

- Renal Impairment: Ciclosporin can affect kidney function, which is why baseline creatinine levels are measured before starting treatment.

- Hyperlipidemia: Elevated cholesterol and triglyceride levels can occur, requiring monitoring and possibly dietary adjustments.

- Gingival Hyperplasia: This condition involves overgrowth of gum tissue and can be bothersome for some patients.

- Hirsutism: Increased hair growth in unwanted areas may also be observed.

- Neurological Effects: Some patients report tremors, fatigue, and headaches.

- Increased Risk of Infections: As an immunosuppressant, ciclosporin can increase susceptibility to infections.

2. Resolution of Side Effects After Discontinuation:
Upon discontinuation of ciclosporin, many side effects can resolve over time. Blood pressure may return to baseline levels, and kidney function can improve, particularly if the drug was used for a short duration. However, the timeline for recovery can vary based on individual health factors and the duration of treatment. Regular follow-up with healthcare providers is essential to monitor recovery and ensure that any potential long-term effects are addressed.

3. Risk of Disease Recurrence:
After stopping ciclosporin, there is a significant possibility that the underlying skin conditions, such as atopic dermatitis or psoriasis, may recur. This recurrence is influenced by various factors, including the severity of the original condition, individual patient characteristics, and the presence of triggers (such as stress, allergens, or environmental factors). To mitigate the risk of relapse, healthcare providers often recommend a comprehensive management plan that may include topical treatments, lifestyle modifications, and possibly other systemic therapies.
In summary, while ciclosporin can provide significant relief for patients with severe atopic dermatitis and psoriasis, it is crucial to be aware of its potential side effects and the likelihood of disease recurrence after discontinuation. Regular monitoring and a collaborative approach with healthcare providers can help manage these risks effectively. Additionally, exploring adjunct therapies and lifestyle changes can further enhance treatment outcomes and improve overall skin health.

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