Clinical profile of cyclosporine in dermatology

Cyclosporine is one of the most effective agents available for the treatment of psoriasis. It is also widely used in atopic dermatitis and other dermatological disorders. Recent consensus guidelines for psoriasis recommend an initial dosage of 2.55?mg/kg/day (in one or two daily doses), with adjustments of 0.51?mg/kg/day every 12 weeks; the maximum daily dosage is 6mg/kg/day. The most widely used cyclosporine schedule is intermittent short-term therapy for 1216 weeks; subsequently, when relapse occurs, treatment is restarted at the previously established, effective dosage. Short-term cyclosporine therapy is also particularly useful as a rescue treatment for severe disease flares, and as a bridging treatment to other maintenance schedules. Hypertension and renal dysfunction are the major tolerability issues, but these are related to dose and treatment duration, and can be markedly reduced if appropriate dosage and monitoring guidelines are followed. Generally, if cyclosporine dosage is maintained at =5mg/kg/day, and treatment duration at =2 years, these events are reversible after treatment is stopped. As definitive clinical experience continues to accrue for several cyclosporine monotherapy and combination regimens in various dermatological disorders, cyclosporine is likely to markedly extend its already integral therapeutic role in dermatology. Drug Dev Res 72:634646, 2011. (c) 2011 Wiley Periodicals, Inc.