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Two observations of the successful treatment of Hailey-Hailey disease with topical tacrolimus ointment were recently reported,1 - 2 including the article by Sand and Thomsen1 in the Cutting Edge section of the ARCHIVES. It is suggested that the mechanism of action of topical tacrolimus in this disease might be related to the immunomodulating effect of the compound.1 We recently used topical tacrolimus in a patient with Hailey-Hailey disease and observed a complete failure of this therapy.
A 60-year-old patient was followed up for Hailey-Hailey disease for several years. Lesions were usually treated with topical and oral antibiotics (dicloxacillin, erythromycin), topical steroids, and vitamin D derivatives. He was seen for a recurrence of typical lesions of Hailey-Hailey disease with superficial erosions involving his neck and axillary region. Two daily applications of 0.1% tacrolimus ointment were started in association with topical antiseptics. He experienced transient burning sensation immediately after each application, with a progressive worsening of the lesions, which led to discontinuation of topical tacrolimus after 12 days. Microbiologic examination of a lesion was positive for Staphylococcus aureus. There was no clinical evidence of herpetic infection, and previous swabs from the patient's lesions have been negative for herpes. The lesions progressively improved with oral antibiotherapy (dicloxacillin) and topical calcipotriol cream.
Local staphylococcal infection may have contributed to the flare of the disease in this patient, and the direct responsibility of topical tacrolimus is difficult to establish. However, topical tacrolimus was recently shown to enhance experimentally induced irritant contact dermatitis.3 This could also explain the worsening of the lesion in our case, as it is well known that minor trauma or local irritation may play a role in the flares of Hailey-Hailey disease.2 There was no clinical evidence for allergic contact dermatitis to topical tacrolimus, as there was no pruritus or vesicles associated with the flare of the Hailey-Hailey lesions; however, patch tests have not been performed.
Thus, we think that topical tacrolimus should be used with caution in patients with Hailey-Hailey disease, in whom local irritation may be deleterious. Furthermore, since the long-term success of topical tacrolimus treatment may progressively decline in recalcitrant cutaneous disorders,4 the failure of this promising therapy should also be reported.
The authors have no relevant financial interest in this letter.
Correspondence: Dr Laffitte, Department of Dermatology and Venerology, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland (emmanuel.laffitte@hospvd.ch).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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