1 - TOPICAL CALCINEURIN INHIBITORS

Question 1

Topical calcineurin inhibitors are free of the adverse effects of topical corticosteroids I.e. atrophy, striae, potential hypothalamo-pituitary-adrenal axis suppression

Answer 1

True

Question 2

Cyclosporine (a calcineurin inhibitor) lacks topical activity because its large molecular weight results in poor epidermal penetration

Answer 2

True

Question 3

Tacrolimus and pimecrolimus have lower molecular weights (than the oral calcineurin inhibitor cyclosporine) and so can penetrate inflamed skin

Answer 3

True

Question 4

Tacrolimus is a macrolide produced by the soil bacterium Streptomyces tsukubaensis

Answer 4

True

Question 5

Tacrolimus’s structure and mechanism of action are similar to those of cyclosporine

Answer 5

True

Question 6

Tacrolimus and pimecrolimus prevents cytokine production and blocks T cell activation and proliferation

Answer 6

True

Question 7

Topical tacrolimus is FDA approved as second line therapy for the short term and non-continuous chronic treatment of moderate to severe atopic dermatitis in immunocompetent adults

Answer 7

True

Question 8

Topical tacrolimus for atopic dermatitis is as effective as moderately potent topical corticosteroids for the trunk and extremities, and superior in efficacy to mild potency corticosteroids for the face and neck

Answer 8

True

Question 9

Chronic atopic dermatitis lesions of the face and flexures are most justified for treatment with topical calcineurin inhibitors

Answer 9

True (topical calcineurin inhibitors have comparatively superior/similar potency to a TCS that would not have been used on the face/flexures due to risk of TCS adverse effects)

Question 10

Tacrolimus 0.1% ointment is similar in efficacy to topical corticosteroids of class I (superpotent) and class II/III (high) potency

Answer 10

True

Question 11

Once the atopic dermatitis has stabilised, proactive maintenance treatment with Tacrolimus 2 or 3 times weekly can significantly prevent flares in paediatric and adult patients

Answer 11

True

Question 12

Tacrolimus ointment may reduce the number of flares and prolonged the time to first flare in atopic dermatitis

Answer 12

True

Question 13

Topical Tacrolimus is more effective than pimecrolimus in adult atopic dermatitis patients

Answer 13

True

Question 14

Topical tacrolimus and Pimecrolimus have similar safety and tolerability profile

Answer 14

True

Question 15

Use of topical tacrolimus ointment in oral lichen planus can result in systemic absorption, though clinically significant adverse events associated with systemic absorption have not been observed

Answer 15

True

Question 16

The efficacy of topical tacrolimus ointment in oral lichen planus is at least equal to those of topical clobetasol propionate 0.05% ointment (superpotent Class I TCS)

Answer 16

True

Question 17

Although there have been 2 cases of oral SCC in oral lichen planus patients after treatment with tacrolimus ointment, further studies will clarify if there is a causal relationship

Answer 17

True

Question 18

Topical tacrolimus 0.03% ointment is generally for paediatric patients and the 0.1% ointment is generally for adult patients

Answer 18

True

Question 19

Topical tacrolimus 0.1% ointment is almost as efficacious as clobetasol propionate 0.05% ointment (superpotent class I TCS) in vitiligo on the face

Answer 19

True

Question 20

Tacrolimus 0.1% ointment has a defined role in facial, inverse and genital psoriasis

Answer 20

True

Question 21

Topical tacrolimus and pimecrolimus, either as monotherapy or combined with oral hydroxychloroquine is effective in cutaneous lupus erythematosus

Answer 21

True (topical tacrolimus and pimecrolimus was equal to clobetasol propionate 0.05% ointment in facial LE)

Question 22

Topical tacrolimus 0.1% ointment and pimecrolimus 1% cream is useful in seborrheic dermatitis

Answer 22

True

Question 23

Open studies have shown favourable results with topical tacrolimus in the treatment of Rosacea

Answer 23

True

Question 24

Tacrolimus 0.1% ointment has shown favourable results in morphea (localised scleroderma)

Answer 24

True

Question 25

Topical tacrolimus may result in local application site irritation

Answer 25

True

Question 26

The localised application site irritation due to topical tacrolimus is transient and decreases in prevalence over time

Answer 26

True

Question 27

Both topical tacrolimus and pimecrolimus are absolutely contraindicated in individuals with hypersensitivity to the active drug or components of the ointment/cream

Answer 27

True

Question 28

Both topical tacrolimus and pimecrolimus are relatively contraindicated in children less than 2 years of age

Answer 28

True

Question 29

Both topical tacrolimus and pimecrolimus are absolutely contraindicated in individuals with an active skin infection at the site to be treated

Answer 29

True

Question 30

Exposure to topical tacrolimus or pimecrolimus is not associated with an increase in the overall cancer rate

Answer 30

True

Question 31

The use of topical tacrolimus may be associated with an increased risk of T-cell lymphoma

Answer 31

True (although this may be inconclusive as another study found no increased risk of lymphoma in patients treated with topical calcineurin inhibitors, and that patients with atopic dermatitis itself was associated with an increased lymphoma risk although this study did not find any cases of lymphoma in topical calcineurin inhibitors users)

Question 32

There is a theoretical risk that topical calcineurin inhibitors may cause lymphoma, although available data on lymphoma following topical calcineurin inhibitor use are inconsistent and insufficient to draw a conclusion about the causal role

Answer 32

True

Question 33

Available data have found no evidence indicating that skin cancer is associated with topical calcineurin inhibitor use

Answer 33

True

Question 34

Combining UVB and tacrolimus seems to have a limited direct photocarcinogenic potential on keratinocytes compared to UVB alone

Answer 34

True

Question 35

Systemic absorption of topical tacrolimus in atopic dermatitis is low and not clinically significant

Answer 35

True (although marked systemic absorption has been observed in Netherton's syndrome)

Question 36

Patients with Netherton's syndrome treated with topical tacrolimus are at risk for systemic absorption of topical tacrolimus

Answer 36

True (serum levels elevated, although no signs or symptoms of toxicity have been observed) - tacrolimus can be switched to pimecrolimus

Question 37

Topical tacrolimus may cause enhanced facial flushing after alcohol ingestion

Answer 37

True

Question 38

Topical Tacrolimus may cause Rosacea-like dermatitis

Answer 38

True (although ironically topical tacrolimus has shown favourable results in Rosacea)

Question 39

Topical tacrolimus may cause acne

Answer 39

True

Question 40

Topical tacrolimus may cause reactivation of HPV infection

Answer 40

True

Question 41

Pimecrolimus is a semi synthetic derivative of the macrolide ascomycin, with a similar structure to that of tacrolimus

Answer 41

True

Question 42

Pimecrolimus appears to have a role in atopic dermatitis of the head and neck

Answer 42

True

Question 43

The need for topical corticosteroids for atopic dermatitis on the head and neck is reduced with pimecrolimus cream

Answer 43

True

Question 44

Intervention with Pimecrolimus cream at the first signs and symptoms of a subsequent recurrence of atopic dermatitis reduced the number of flares/prevented progression to flares requiring topical corticosteroids

Answer 44

True

Question 45

The efficacy of pimecrolimus 1% cream in oral lichen planus is equal to topical Triamcinolone Acetonide 0.1% paste (moderately potent Class IV/V TCS)

Answer 45

True

Question 46

Pimecrolimus 1% cream + NB-UVB is superior to placebo + NB-UVB for facial vitiligo lesions

Answer 46

True

Question 47

Pimecrolimus 1% cream is equal in efficacy to mometasone furoate 0.1% cream (High potency Class II/III TCS) and clobetasol propionate 0.05% ointment (Superpotent Class I TCS) for facial vitiligo lesions

Answer 47

True

Question 48

The role of pimecrolimus in inverse psoriasis is inconclusive

Answer 48

True (unlike tacrolimus, which has shown clear benefit for facial, genital and inverse psoriasis)

Question 49

Pimecrolimus 1% cream has comparable efficacy to ketoconazole for seborrheic dermatitis, but adverse effects appeared more with pimecrolimus

Answer 49

True

Question 50

Pimecrolimus 1% cream is effective in corticosteroid-induced Rosacea

Answer 50

True

Question 51

Topical Pimecrolimus has successfully treated Netherton's syndrome

Answer 51

True (increased absorption and systemic toxicity from topical tacrolimus)

Question 52

There is no increase of systemic absorption of topical pimecrolimus with increasing body surface area treated

Answer 52

True (and no drug related systemic adverse events)

Question 53

The order of decreasing potency for topical calcineurin inhibitors are Tacrolimus 0.1% > Tacrolimus 0.03% > Pimecrolimus 1%

Answer 53

True

Question 54

Topical pimecrolimus has not been associated with drug related systemic events

Answer 54

True

Question 55

The use of pimecrolimus cream results in minimal systemic absorption

Answer 55

True

Question 56

Topical pimecrolimus does not increase the risk of malignancy

Answer 56

True (this risk is unclear with topical tacrolimus and lymphoma due to mixed data)

Question 57

Topical pimecrolimus may cause enhancement of molluscum contagiosum

Answer 57

True