Calcineurin Inhibitors

Cyclosporine A (CsA), tacrolimus and pimecrolimus are calcineurin inhibitors that affect T cell function and growth. CsA and tacrolimus have been used for the treatment of autoimmune blistering diseases, but are limited by a number of side effects including renal toxicity and hypertension. Several small studies indicate that oral CsA, used in lower doses, can be effective in controlling blister formation in patients with autoimmune bullous diseases while minimizing systemic toxicity. In addition, topical intraoral CsA solution has been effective for controlling mouth blisters and erosions in these patients. To date little information exists on the use of tacrolimus, but it is believed that this agent also could be effective for treating autoimmune bullous disorders. This article outlines the effects and side effects of CsA, tacrolimus and pimecrolimus and reviews their utility in the treatment of autoimmune blistering diseases.