Gupta A K, Brown M D, Ellis C N, Rocher L L, Fisher G J, Baadsgaard O, Cooper K D, Voorhees J J
Department of Dermatology, University of Michigan Medical Center, Ann Arbor 48109-0314.
J Am Acad Dermatol. 1989 Dec;21(6):1245-56. doi: 10.1016/s0190-9622(89)70339-x.
Cyclosporine is a potent immunosuppressive agent with no appreciable effect on the bone marrow and a selective inhibitory effect on helper T cells. Oral cyclosporine was first used to prevent organ rejection but also has been reported to be effective in other disorders. In cutaneous diseases that respond to oral cyclosporine helper T cells appear to be involved in their pathogenesis. This article reviews the cutaneous diseases that have been treated with cyclosporine and its pharmacology and side effects. Two significant adverse side effects are renal dysfunction and hypertension, both of which are reversible when short-term low-dose (less than 5 mg/kg per day) oral cyclosporine is discontinued. Lymphoma is unlikely in an otherwise healthy patient who has received low-dose oral cyclosporine for limited periods. The use of oral cyclosporine in any patient should be carefully considered in terms of the risk/benefit ratio and needs to be carried out under close medical supervision. In view of the limited experience with cyclosporine in dermatology, whenever possible its use should be confined to formal clinical studies with established protocols and guidelines. Further controlled studies need to be performed to evaluate the efficacy of low-dose cyclosporine in many dermatoses and its side-effect profile, particularly over the long term.
环孢素是一种强效免疫抑制剂，对骨髓无明显影响，对辅助性T细胞有选择性抑制作用。口服环孢素最初用于预防器官排斥反应，但也有报道称其在其他疾病中有效。在对口服环孢素有效的皮肤病中，辅助性T细胞似乎参与了其发病机制。本文综述了已用环孢素治疗的皮肤病及其药理学和副作用。两个显著的不良副作用是肾功能不全和高血压，当停用短期低剂量（每天小于5mg/kg）口服环孢素时，这两种副作用都是可逆的。在健康状况良好的患者中，短期小剂量口服环孢素不太可能引发淋巴瘤。对于任何患者，使用口服环孢素都应根据风险/效益比仔细考虑，并且需要在密切的医疗监督下进行。鉴于环孢素在皮肤科的经验有限，只要有可能，其使用应限于遵循既定方案和指南的正规临床研究。需要进行进一步的对照研究，以评估低剂量环孢素在许多皮肤病中的疗效及其副作用情况，尤其是长期副作用。
