The Use of Cyclosporine in Dermatology

August 2012 | Volume 11 | Issue 8 | Original Article | 979 | Copyright © August 2012

overall lack of controlled trials with cyclosporine in these diseases, due to the fact that in most of the cases, cyclosporine was used as a third-line treatment after other options failed. There are also isolated case reports where cyclosporine has shown good results, including diseases such as granuloma annulare in its elastolytic form,133 hypereosinophilic syndrome,134 Kimura's disease,135,136 eosinophilic pustulosis,137 metastatic Crohn's disease,138,139 necrobiosis lipoidica,140 panniculitis,141-143 IgA pemphigus,144 paraneoplastic pemphigus,145 impetigo herpetiformes, 146 sleromyxedema,147 and xanthomas.148


Although moderate to severe psoriasis remains the only FDAapproved indication for the use of cyclosporine in dermatology, the drug has been used with very good results for the treatment of multiple dermatologic conditions, including atopic dermatitis, neutrophilic dermatoses, connective tissue disorders, and autoimmune bullous diseases among others. In our opinion, cyclosporine plays an essential role in the dermatologic therapeutic arsenal due to its efficacy and rapid onset of action. Furthermore, short-term therapy and low doses translate into fewer side effects. It is also important to note that in dermatology, cyclosporine is frequently used as monotherapy and therefore the rates of complication are seen in a small percentage of patients.


Dr. Kerdel has received grants, participated in advisory boards, and is a speaker for Abbott, Amgen, Wyeth, Astellas, Centocor, Genentech, Stiefel, Eisai, Pfizer, Celgene, Merck, and Novartis. Drs. Dehesa, Abuchar, Vitiello, and Nuno have disclosed no relevant conflicts of interest.


  1. Amor K, Catriona R, et al. The use of cyclosporine in dermatology: Part I. J Am Acad Dermatol 2010; 63: 925-46.
  2. Mueller W, Hermann B. Cyclosporin A for psoriasis. N Engl J Med 1979;301: 555.
  3. Griffiths CEM, Powles AV, Leonard JN, Fry L. Clearance of psoriasis with low dose cyclosporine. Br Med J 1986; 293: 731-2.
  4. Feutren G, Friend D, Timonen P, Laburte C. Cyclosporin monitoring in psoriasis. Lancet 1990;335: 866-7.
  5. Timonen P, Friend D, Abeywickrama K, Laburte C, Von Graffenried B, Feutren G. Efficacy of low-dose cyclosporine A in psoriasis: results of dosefinding studies. Br J Dermatol 1990;122:33-9.
  6. Ellis CN, Fradin MS, Messana JM, Brown MD, Siegel MT, Hartley AH, et al. Cyclosporine for plaque-type psoriasis. Results of a multidose, doubleblind trial. N Engl J Med 1991; 324:277-84.
  7. Christophers E, Mrowietz U, Henneick HH, Färber L, Welzel D. Cyclosporine in psoriasis: a multicenter dose-finding study in severe plaque psoriaisis. J Am Acad Dermatol 1992;26:86-90.
  8. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009;61:451-85.
  9. Ellis CN, Fradin MS, Messana JM et al. Cyclosporine for plaque-type psoriasis. Results of a multidose, double-blind trial. N Engl J Med 1991;324: 277-284.
  10. Ho VC, Griffiths CE, Berth-Jones J et al. Intermittent short courses of cyclosporine microemulsion for the long-term management of psoriasis: a 2-year cohort study. J Am Acad Dermatol 2001; 44: 643-651.
  11. Marcil I, Stern RS. Squamous-cell cancer of the skin in patients given PUVA and ciclosporin: nested cohort crossover study. Lancet 2001;358: 1042-1045.
  12. Paul CF, Ho VC, McGeown C et al. Risk of malignancies in psoriasis treated with cyclosporine: a 5-yr cohort study. J Invest Dermatol 2003; 120: 211-6.
  13. Lebwohl M, Ellis C, Gottlieb A, Koo J, Krueger G, Linden K, et al. Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. J Am Acad Dermatol 1998;39:464-75.
  14. Griffiths CE, Katsambas A, Dijkmans BA, Finlay AY, Ho VC, Johnston A, et al. Update on the use of ciclosporin in immune-mediated dermatoses. Br J Dermatol 2006;155:1-16.
  15. Berth-Jones J, Henderson CA, Munro CS, Rogers S, Chalmers RJG, Boffa MJ, et al. Treatment of psoriasis with intermittent short course cyclosporine (Neoral). A multicenter study. Br J Dermatol 1997;136:527-30.
  16. Ho VC, Griffiths CE, Albrecht G, Vanaclocha F, Leó n-Dorantes G, Atakan N, et al. Intermittent short courses of cyclosporine (Neoral) for psoriasis unresponsive to topical therapy: a 1-year multicentre, randomized study. The PISCES Study Group. Br J Dermatol 1999;141:283-91.
  17. Ho VC, Griffiths CE, Berth-Jones J, Papp KA, Vanaclocha F, Dauden E, et al. Intermittent short courses of cyclosporine microemulsion for the long-term management of psoriasis: a 2-year cohort study. J Am Acad Dermatol 2001;44:643-51.
  18. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009;23:1-70.
  19. Menter MA, See JA, Amend WJ, Ellis CN, Krueger GG, Lebwohl M, et al. Proceedings of the psoriasis combination and rotation therapy conference. Deer Valley, Utah, Oct. 7-9, 1994. J Am Acad Dermatol 1996;34:315-21.
  20. Griffiths CEM, Powles AV, McFadden J, Baker BS, Valdimarsson H, Fry L. Long term cyclosporine for psoriasis. Br J Dermatol 1989;120:256-66.
  21. Ozawa A, Sugai J, Ohkido M, Ohtsuki M, Nakagawa H, Kitahara H, et al. Cyclosporin in psoriasis: continuous monotherapy versus intermittent longterm therapy. Eur J Dermatol 1999;9:218-23.
  22. Grossman RM, Thivolet J, Claudy A, Souteyrand P, Guilhou JJ, Thomas P, et al. A novel therapeutic approach to psoriasis with combination calcipotriol ointment and very low-dose cyclosporine: results of a multicenter placebocontrolled study. J Am Acad Dermatol 1994;31:68-74.
  23. Gottlieb SL, Heftler NS, Gilleaudeau P, Johnson R, Vallat VP, Wolfe J, et al. Short-contact anthralin treatment augments therapeutic efficacy of cyclosporine in psoriasis: a clinical and pathologic study. J Am Acad Dermatol 1995;33:637-45.
  24. Abel EA. Phototherapy: Uvb and PUVA. Cutis 1999;64:339-42.
  25. Korstanje MJ, Hulsmans RF. Combination therapy cyclosporine A-PUVA in psoriasis. Acta Derm Venereol 1990;70:89-90.
  26. Momtaz TK, Fitzpatrick TB. Modifications of PUVA. Dermatol Clin 1995;13:867-73.
  27. van de Kerkhof PC. Therapeutic strategies: rotational therapy and combinations. Clin Exp Dermatol 2001;26:356-61.
  28. van de Kerkhof PC, de Rooij MJ. Multiple squamous cell carcinomas in a psoriatic patient following high-dose photochemotherapy and cyclosporin treatment: response to long-term acitretin maintenance. Br J Dermatol 1997;136:275-8.
  29. Fraser AD, van Kuijk AW, Westhovens R, Karim Z, Wakefield R, Gerards AH, et al. A randomized, double blind, placebo controlled, multicenter trial of combination therapy with methotrexate plus cyclosporin in patients with active psoriatic arthritis. Ann Rheum Dis 2005;64:859-64.
  30. Mazzanti G, Coloni L, De Sabbata G, Paladini G. Methotrexate and cyclosporin combined therapy in severe psoriatic arthritis: a pilot study. Acta Derm Venereol Suppl (Stockh) 1994;186:116-7.
  31. Aydin F, Canturk T, Senturk N, Turanli AY. Methotrexate and cyclosporin combination for the treatment of severe psoriasis. Clin Exp Dermatol 2006;31:520-4.
  32. Wong KC, Georgouras K. Low dose cyclosporin A and methotrexate in the treatment of psoriasis. Acta Derm Venereol 1999;79:87.
  33. Gul U, Gonul M, Kilic A, Erdem R, Cakmak SK, Gunduz H. Treatment of psoriatic arthritis with etanercept, methotrexate, and cyclosporin A. Clin Ther 2006;28:251-4.
  34. Clark CM, Kirby B, Morris AD, Davison S, Zaki I, Emerson R, et al. Combination treatment with methotrexate and cyclosporine for severe recalcitrant psoriasis. Br J Dermatol 1999; 141:279-82.
  35. Nijsten TE, Stern RS. Oral retinoid use reduces cutaneous squamous cell carcinoma risk in patients with psoriasis treated with psoralen-UVA: a nested cohort study. J Am Acad Dermatol 2003; 49: 644-50.
  36. Marquez C, Bair SM, Smithberger E, Cherpelis BS, Glass LF. Systemic retinoids for chemoprevention of non-melanoma skin cancer in high-risk patients. J Drugs Dermatol. 2010;9(7):753-8.
  37. Lebwohl M. Combining the new biologic agents with our current psoriasis armamentarium. J Am Acad Dermatol 2003;49(Suppl):S118-24.
  38. Cather JC, Menter A. Combining traditional agents and biologics for the treatment of psoriasis. Semin Cutan Med Surg 2005;24:37-45.
  39. Stebbins WG, Lebwohl MG. Biologics in combination with nonbiologics: efficacy and safety. Dermatol Ther 2004;17:432-40.
  40. Tuxen AJ, Yong MK, Street AC, Dolianitis C. Disseminated cryptococcal infection in a patient with severe psoriasis treated with efalizumab, methotrexate and cyclosporin. Br J Dermatol 2007;157:1067-8.