Nail changes in alopecia areata: frequency and clinical presentation
© 2008 The Authors JEADV 2009, 23, 169–243 Journal compilation © 2008 European Academy of Dermatology and Venereology planus, vitiligo, leg ulcers, pyoderma gangrenosum and steroidinduced rosacea.3 It inhibits cytosine transcription, activates T cells by binding to immunophilins and blocks calcineurin phosphatase activity in the same way as cyclosporin but with a 10–100 times higher potency.4 It also blocks release of histamine from mast cells and penetrates human skin to mediate its activity akin to mid potency topical steroids without any effects on blood vessels. In steroid-induced rosacea, tacrolimus probably mediates its effects through its potent immunosuppressive action and also inhibiting local humoral and cellular immune mechanisms induced by increased microbial counts.4,5 Tacrolimus probably improves rosacea through its strong immunosuppressive effects, as it lacks any significant vascular effects, which may directly counteract vascular disturbances of rosacea.6 This non-steroidal potent topical immunomodulatory agent without inherent adverse effects of topical corticosteroids holds a good promise as an alternative in conditions like rosacea where immunosuppressive effects are required but topical steroids are contraindicated. Further studies having a double-blind and placebo-controlled design are required to ascertain the effective concentration, formulation and duration of therapy with tacrolimus in rosacea.