In vivo confocal reflectance microscopy for the characterization of melanocytic nests and correlation with dermoscopy and histology

Transcription of early T-cell activation genes for interleukin (IL)-2, IL-3, IL-4, IL-5, granulocyte-macrophage colonystimulating factor and tumour necrosis factor-a is then inhibited. In addition to atopic dermatitis, calcineurin inhibitors have been reported to give successful treatment of several inflammatory and autoimmune skin diseases including contact dermatitis, psoriasis vulgaris, alopecia areata and chronic discoid lupus erythematosus. LIS is regarded by some as a nonscarring form of discoid lupus erythematosus. It therefore appears reasonable to infer that topical calcineurin inhibitors may be useful in treating LIS. The course of LIS is unpredictable. Most patients experience a waxing and waning course marked by intermittent improvement and subsequent exacerbation, which makes the evaluation of therapeutic effectiveness difficult. The rapid clinical response of our patient was more likely to be due to the effect of topical calcineurin inhibitors rather than to a natural course. In addition, the absence of recurrence of the skin eruptions during treatment also supported the effectiveness of topical calcineurin inhibitors in LIS. The most frequent adverse events associated with topical tacrolimus are a burning sensation, pruritus and erythema at the site of application. All these events are generally mild in nature and transient. Interestingly, the adverse event our patient experienced occurred after tacrolimus had been used for 2 weeks. Such a late-onset phenomenon has not been mentioned in the literature. Because of the uncertain risks of topical calcineurin inhibitors on photocarcinogenesis in humans, caution should be exercised in treating patients with LIS in sun-exposed areas. In addition, coexistent herpes simplex infection on the face is not uncommon. Topical calcineurin inhibitors should be avoided during active infection. Our results suggest that topical calcineurin inhibitors offer an effective treatment for LIS.