**7. References**

Chaudhari U, Romano P, Mulcahy LD, Dooley LT, Baker DG, Gottlieb AB.


**1. Introduction** 

 \*

Corresponding Author

urticaria (Amor et al., 2010; Vena et al., 2006).

**14** 

 *Italy* 

**Systemic Cyclosporin** 

**in the Treatment of Psoriasis** 

Cyclosporin was isolated in 1970, by Jean François Borel at Sandoz Laboratories (Basel, Switzerland), from the soil fungus *Tolypocladium inflatum* (Borel et al., 1995; Amor et al., 2010). The compound was initially identified as a possible antifungal agent, but it was subsequently shown to have limited antifungal activity. However, in 1976, the drug demonstrated potent immunosuppressive properties, and two years later, it was successfully shown to prevent renal allograft rejection in renal transplant recipients. A year later, a pilot study showed that cyclosporin improved psoriasis in patients treated for rheumatoid and psoriatic arthritis. Ultimately, in the early 1990s, cyclosporin was approved in Europe for the treatment of psoriasis and atopic dermatitis. In 1997, the United States Food and Drug Administration approved a microemulsion formulation of cyclosporin (Neoral®; Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA) for the treatment of severe psoriasis in adults. Worldwide, cyclosporin has been used extensively in various dermatological disorders: e.g. pyoderma gangrenosum, and refractory chronic idiopathic

Despite such a distinguished clinical history, some dermatologists have been rather hesitant to use cyclosporin because of concerns about possible adverse effects (Amor et al., 2010; Ryan et al., 2010); however a 'framework' of detailed clinical data now widely supports the effective and safe use of cyclosporin within dermatologists' prescribing guidelines, especially when the drug is used as a 'rescue', or intermittent short-term treatment for

Another particularly pertinent consideration is that 'conventional' and generic (including generic microemulsion) formulations of cyclosporin are associated with marked intra- and interindividual variability in absorption, thus creating the potential for subtherapeutic dosing at one extreme and toxicity at the other (Colombo & Egan, 2010; Ryan et al., 2010). For this reason, generic formulations have not yet been approved in several countries. Conversely, the microemulsion Neoral® preparation is associated with low intra- and interpatient variability in cyclosporin absorption and with a consistent dose-exposure relationship. This highlights the importance of prescribing the most clinically appropriate

severe psoriasis, psoriatic arthritis, or atopic dermatitis (Amor et al., 2010).

Delia Colombo\* and Antonino Di Pietro *1Ospedale Luigi Marchesi, Via Marchesi, Milano* 

Warren RB,Brown BC, Carmichael AJ, Griffiths CEM. Long-term control of recalcitrant psoriasis with combination infliximab and methotrexate. Clinical and Experimental Dermatology, 34, 415-6.
