Use of topical cyclosporin for conjunctival manifestations of actinic prurigo

doi:10.1016/S0002-9394(00)00619-X

American Journal of Ophthalmology

Volume 130, Issue 6, December 2000, Pages 830-831

https://doi.org/10.1016/S0002-9394(00)00619-X Get rights and content

Abstract

PURPOSE: To report the successful treatment of conjunctival manifestations of actinic prurigo with topical cyclosporin.

METHODS: A 12-year-old female with extensive limbal lesions and chronic conjunctivitis secondary to actinic prurigo was treated with topical cyclosporin, and a rapid clinical response was observed.

RESULTS: The patient had the limbal lesions surgically excised. The lesions completely recurred over the first 2 postoperative months. Treatment with topical steroids and vitamin A ointment was unsuccessful. The patient was then treated with cyclosporine 2% drops and a dramatic improvement occurred. Over a 3-month period, the lesions completely resolved.

CONCLUSION: Cyclosporine eyedrops may be an effective treatment for the conjunctival manifestations of actinic prurigo.

References (3)

M.T. Hojyo-Tomoka et al.
Actinic prurigoclinical-pathological correlation
Int J Dermatol
(1978)

There are more references available in the full text version of this article.

Cited by (14)

Photosensitive disorders of the skin with ocular involvement
2015, Clinics in Dermatology
Citation Excerpt :
Mainstays of treatment include strict photoprotection, topical corticosteroids, and topical calcineurin inhibitors for mild disease and NB-UVB, PUVA, or oral thalidomide for more severe disease. Ophthalmic treatments include surgical excision of the conjunctival lesions and treatment with topical cyclosporine eye drops in cases of treatment failure with topical steroids and vitamin A ointments.5 Chronic actinic dermatitis (CAD) is an uncommon, chronic eczematous dermatitis with a predominant photodistribution and, clinically and histologically, lichenification.
Patients with photosensitive disorders of the skin may present with ocular manifestations that are evident at birth or may be manifested later with progression of the disorder. Dermatologists should be able to recognize these and appropriately refer patients for further management. Ocular involvement associated with immunologically mediated photodermatoses, drug- and chemical-induced photosensitivity, photodermatoses associated with defective DNA repair/chromosome instability, and photoaggravated dermatoses are reviewed.
Photodermatoses are commonly classified into four general groups: (1) immunologically mediated photodermatoses; (2) drug- and chemical-induced photosensitivity; (3) photodermatoses associated with defective DNA repair/chromosome instability; and (4) photoaggravated dermatoses. Photodermatoses in these groups with ocular involvement will be discussed. In addition, skin diseases associated with photophobia are also described.
Actinic prurigo
2014, Dermatologic Clinics
Citation Excerpt :
Oral cyclosporine (2.5 mg/kg/d for 6–8 months)53 and azathioprine (50–100 mg/d for 8 months)44 have been used with some success in a few refractory cases. Efficacy of topical 2% cyclosporine ophthalmic solution has been reported for the treatment of ocular AP lesions, with a dosage of 2 or 3 drops daily for 3 months.95,96 AP is a chronic, immunologically mediated photodermatosis associated with HLA DRB1*0407, a common allele in Central America and some regions of North and South America.
Actinic conjunctivitis in children: Clinical features, relation to sun exposure, and proposed staging and treatment
2009, Journal of AAPOS
Citation Excerpt :
Although there is an allergic component, it appears to be primarily a photosensitive reaction. Actinic conjunctivitis has been only described in Mestizo, Indian, and American Indian populations.1-8 The evidence that actinic conjunctivitis is primarily a reaction to sunlight in susceptible individuals, rather than primarily an allergic response, was proposed as early as 1941 by Solares5 in his description of actinic conjunctivitis in Indians and Mestizos in the highlands of Bolivia.
Actinic conjunctivitis is an ocular photosensitivity reaction found mainly in children in certain populations in the Andean regions of South America, Mexico, and in the southwestern United States. Its clinical features, treatment, and possible relation to duration of sun exposure have not been fully described in the ophthalmologic literature.
A 20-member ophthalmic team traveled to an Andean region of Ecuador to provide ophthalmic care to children. All children with conjunctivitis were examined. A novel 3-stage classification of actinic conjunctivitis, devised by one of the authors, was used to stage the disease. The parents of each child with actinic conjunctivitis were asked how much time the child spent outside. Histopathological evaluations were performed on children who underwent surgery.
A total of 206 children were examined, of whom 36 had changes consistent with actinic conjunctivitis. Stage 1 disease was diagnosed in 17 children, stage 2 in 9, and stage 3 in 10 in the most severely affected eye. The amount of time the child spent outside correlated with disease severity (r = 0.77, p < 0.001). Histopathologic samples showed an intense inflammatory response with hyperplasia of the vascular endothelium, pigmentary migration, and occasional eosinophilia.
Actinic conjunctivitis is prevalent among children of the highlands of Ecuador. Although it has an allergic component, our data suggest that the severity of the disease is significantly associated with sun exposure. The finding that the lesions are found only in the exposed conjunctiva supports the hypothesis that UV exposure is the main cause of the disease.
Cyclosporine 2% eye drops preparation
2004, Journal Francais d'Ophtalmologie
L’administration de ciclosporine est très efficace lors de certaines maladies immunologiques de la cornée, de la conjonctive et de l’uvée. De plus, elle se révèle très précieuse lors des kératoplasties à risque de rejet élevé. Nous proposons un mode opératoire permettant la préparation d’un collyre de ciclosporine à 2 %.
La formulation choisie fait appel, d’une part à la préparation buvable de ciclosporine (Sandimmun^® buvable), d’autre part à de l’huile de ricin stérile. Les conditions de fabrication maintiennent la continuité de l’état stérile grâce à une hotte à flux laminaire vertical placée dans une salle blanche, les opérateurs étant revêtus de tenues stériles. Les contrôles physico-chimiques réalisés en cours de fabrication et à l’issue de la préparation de chaque lot par chromatographie liquide à haute performance (polarisation de phase inversée) minimisent les risques de rejets de lots. Des dosages sanguins réalisés après la première administration et à la 24^e heure (soit après l’administration de la 6^e goutte) permettent de vérifier l’éventuel passage systémique.
La préparation offre une bonne stabilité puisque les concentrations en principe actif au 12^e mois après fabrication sont conservées par rapport à la concentration au moment de la fabrication. Administré à raison de 6 gouttes par jour, ce collyre de ciclosporine à 2 % présente une très faible biodisponibilité systémique puisque les concentrations sanguines mesurées sont inférieures à la limite de détection de la méthode immunochimique par polarisation de fluorescence.
Le mode de préparation de ce collyre de ciclosporine 2 % est accessible à une pharmacie hospitalière. La stabilité de la préparation et les différents contrôles permettent d’assurer une qualité du produit conforme aux recommandations de la Pharmacopée Européenne. Il n’y a pas de passage systémique et aucun effet indésirable local ou signe de toxicité générale n’a été signalé, sans doute en rapport avec la très faible concentration en éthanol de la préparation.
Cyclosporine administration is very effective in the case of immunological diseases of the cornea, conjunctive or uvea. Moreover, it is widely used in the case of high-risk rejection corneal transplantation. We present a preparation of cyclosporine 2% eye drops.
Cyclosporine 2% eye drops are prepared following a particular formulation including one part commercially available cyclosporine oral solution (Sandimmun^®) diluted in four parts of sterile castor oil. Manufacturing procedures maintain the sterile state of the preparation with a laminar airflow hood placed in a particulate controlled room, with pharmacists, technicians and clerical personnel wearing sterile clothes. Physical and chemical monitoring during and after manufacture for each batch guarantees the process and minimizes the risk of batch rejection. Chemical analysis of cyclosporine is conducted using a validated stability-indicating high-performance liquid chromatographic assay (reverse-phase). Blood dosages taken after the first administration at the 24^th hour (after administration of the 6^th drop) check for systemic integration.
Cyclosporine 2% eye drops are fairly stable: 12 months after manufacturing, concentrations result in levels not statistically different from concentrations measured the day of preparation. After a daily regimen of six drops in the eye, cyclosporine 2% eye drops have a very low systemic bioavailability, because the blood concentrations only reach the detection limit of the fluorescence polarization immunoassay used for cyclosporine drug monitoring. This explains the absence of systemic toxicity.
Cyclosporine 2% eye drops can be available in the hospital pharmacy. The eye drops are stable at room temperature and can be delivered up to 12 months after manufacture. No local adverse effects have been noted, probably in relation with the very low concentration of ethanol in the ocular preparation.
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^☆: Supported in part by a grant from the Prevent Blindness Foundation, Brisbane, Australia.

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Brief reportUse of topical cyclosporin for conjunctival manifestations of actinic prurigo☆

Abstract

Actinic prurigoclinical-pathological correlation

Int J Dermatol

Brief report
Use of topical cyclosporin for conjunctival manifestations of actinic prurigo☆