Journal of the Dermatology Nurses' Association - Featured Journal
June 2011, Volume 3 Number 3 , p 161 - 162
Cyclosporine is an immunosuppressive drug used in dermatology in the treatment of inflammatory skin diseases such as psoriasis or severe recalcitrant atopic dermatitis.Cyclosporine was discovered in 1970. It was isolated from the soil fungus Tolypocladium inflatum gams, and 6 years later in 1976, its clinical immunosuppressive effects were realized. It was during a clinical trial in 1979 that cyclosporine was found to improve psoriasis skin lesions in patients who had psoriatic arthritis (Wolverton, 2007).Although the mechanism of cyclosporine is not completely understood, in psoriasis, it is known for its effect on T lymphocytes. Cyclosporine inhibits interleukin-2 (IL-2; an inflammatory cytokine) by inhibiting calcineurin, an intracellular enzyme. The inhibition of calcineurin results in the decreased activity of the transcription factor (nuclear factor of activated T cells or NFAT-1), which regulates the transcription of cytokine genes, including IL-2. Activation and proliferation of helper T cells and cytotoxic T cells is stimulated by IL-2; hence, the impaired production of IL-2 leads to a decrease in the number of activated helper T cells and cytotoxic T cells in the epidermis. Cyclosporine also inhibits production of interferon-[gamma], which then down-regulates the production of intercellular adhesion molecule 1. Intercellular adhesion molecule 1 is found on the surface of keratinocytes and dermal capillary endothelium and has influence over inflammatory cells, contributing to the inflammatory response in psoriasis and atopic dermatitis (Bolognia, Jorizzo, & Rapini, 2008).Sandimmune is the original preparation, and Neoral is a predigested microemulsion that is more completely and consistently absorbed. Neoral is FDA approved for psoriasis and rheumatoid arthritis and is available in solution or capsules (Wolverton, 2007).Novartis Pharmaceuticals.Immunosuppressive and antirheumatic.Cyclosporine is FDA approved for severe, recalcitrant, or disabling psoriasis.