Pediatric Rheumatology Online Journal → July 2003 → Dermatomyositis → Treatment → Abstract #126

TOPICAL TACROLIMUS FOR THE TREATMENT OF THE CUTANEOUS MANIFESTATIONS OF JUVENILE DERMATOMYOSITIS

B. A. Lang,¹ A. M. Huber,¹ S. E. Ramsey,¹ L. A. Finlayson.²

¹Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; ²Medicine, Dalhousie University/IWK Health Centre, Halifax, NS, Canada

Topical tacrolimus is a locally immunomodulatory agent which has been used in various inflammatory skin conditions including atopic dermatitis where large studies have shown it to be effective and safe in children. We report our experience in 3 patients with juvenile dermatomyositis (JDM).
Patients and Methods: Three JDM patients with classic skin rash were treated with tacrolimus ointment (0.03-0.1%) which was applied to affected areas twice daily. None received concurrent topical steroids or had increased systemic therapy in the previous 3 months. Patient 1, a 15 year old girl with JDM since age 4, had inactive muscle disease but severe, persistent rash refractory to steroids, hydroxychloroquine and methotrexate. Patient 2, a 9 year old boy with JDM since age 3, had inactive muscle disease but a recent, isolated flare of skin rash despite systemic therapy. Patient 3, a 3 year old boy with new onset JDM, had classic rash without evidence of myositis. Effectiveness of treatment was measured by means of patient/parent report and physical examination.
Results: Patient 1 had resolution or marked improvement in all areas of rash after 4 weeks. This response has been sustained with continued treatment up to 9 months. Patient 2 had marked improvement after 7 weeks which has also been sustained up to 18 weeks with continued treatment. Both patients have mild residual gottron[rsquo>s papules. Patient 3 had no improvement after approximately 8 weeks and started systemic therapy after the new onset of active myositis several months later. No adverse effects were noted in any patients.
Conclusion: Topical tacrolimus may be very effective in some JDM patients with rash unresponsive to systemic therapy. However, its effect is variable and future studies are needed to determine which patients are likely to benefit.