As you know, we have had a lot of success using a patient’s own platelet rich plasma which is made preservative free as drops for patients with chemical burns, ocular surface disease, corneal infections, allergic conjunctivitis, VKC, and dry eye disease.
The study done below** on dogs below shows PRP drops significantly decreases inflammatory cells. The other tools to assess dryness are slightly more subjective, but showed significant improvement as well though the dogs needed multiple courses of PRP injections.
Topical tacrolimus has been used for years to treat inflammatory skin conditions like atopic dermatitis (eczema) and even allergic conjunctivits by suppressing the immune response in the skin. While it can be effective, there are several risks and potential side effects associated with its use (unlikely PRP):
Common Side Effects
1. Burning or Stinging Sensation: Often experienced during the initial days of treatment.
2. Skin Redness or Irritation: The treated area may become red and irritated.
3. Itching: Increased itching at the site of application.
Serious Side Effects: less common but can occur
1. Skin Infections: Since tacrolimus suppresses the immune response, there is an increased risk of skin infections.
2. Herpes Infections: Reactivation of herpes simplex virus infections, including cold sores or genital herpes.
3. Lymphoma and Skin Cancer: There have been rare reports of lymphoma and skin cancer in patients using topical tacrolimus. However, the risk is not fully understood, and the FDA has issued a black box warning to highlight this potential risk.
4. Sun Sensitivity: Increased sensitivity to sunlight, requiring precautions like wearing protective clothing and using sunscreen.
Other Considerations
1. Use in Children: Topical tacrolimus is approved for use in children over the age of 2, but long-term safety in this population is still being studied.
2. Long-term Use: The safety of long-term continuous use of topical tacrolimus has not been established. It is usually recommended for short-term or intermittent use.
3. Alcohol Interaction:Some people experience facial flushing or skin irritation when they consume alcohol while using topical tacrolimus.
Precautions:
- Application Area:Avoid using the ointment on infected skin areas or open wounds.
- Occlusive Dressings: Do not use with occlusive dressings that cover the skin tightly, as this can increase absorption and potential side effects.
-Other Skin Products: Be cautious when using other skin products that can cause irritation or interact with tacrolimus.
While topical tacrolimus can be an effective treatment for atopic dermatitis and other inflammatory skin conditions, it is important to use it under medical supervision due to the potential risks and side effects. Regular follow-ups are essential to monitor for any adverse effects and to ensure the medication is being used safely and effectively.
Long-term outcomes of 0.1% tacrolimus eye drops in eyes with severe allergic conjunctival diseases
Abstract
Background
Because atopic dermatitis does not heal completely, associated severe atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) often require long-term treatment. This study aims to evaluate the long-term outcomes of using 0.1% tacrolimus eye drops to treat these severe allergic conjunctival diseases.
Methods
Two-hundred-and-seventy eyes of 135 patients diagnosed with AKC or VKC from April 2004 to April 2014 were screened retrospectively. Patient demographics and objective signs were extracted from the electronic medical records. The severity of 10 objective signs, related to the palpebral and bulbar conjunctiva, limbus, and cornea, and intraocular pressure (IOP) were observed at baseline, at 2 weeks, 1, 2, 3, 6, and 12 months after starting treatment, and every 1 year thereafter (average use period: 8.4 ± 2.9 years). Safety was evaluated based on the incidence and severity of adverse events.
Results
12 patients (AKC; 7 cases, VKC; 5 cases) who were treated with 0.1% tacrolimus eye drops were enrolled in this study. The total score of clinical signs significantly decreased after 2 weeks and remained effective thereafter. Tacrolimus eye drops elicited a statistically significant difference in the mean total clinical scores and IOP over the course of treatment (P < 0.001). Elevated IOP was observed in 2 cases and corneal infection in 1 case; these effects were completely controlled with medication.
Conclusions
Topical tacrolimus may provide effective and long-term improvement in clinical signs of severe AKC and VKC cases that refractory to standard conventional treatment.
**
Comparison of topical 0.03% tacrolimus and homologous injectable platelet-rich plasma in the treatment of keratoconjunctivitis sicca in dogs
- PMID: 36855346
- PMCID: PMC9967714
- DOI: 10.14202/vetworld.2023.134-143
Abstract
Background and aim: Keratoconjunctivitis sicca (KCS) is predominantly an immune-mediated chronic inflammatory ocular disease that is commonly diagnosed in dogs. This study aimed to compare the conventional use of topical immunosuppressant tacrolimus 0.03% eye drops and a new therapy injectable homologous platelet-rich plasma (HPRP) into the third eyelid gland and inferior and superior palpebral conjunctiva of dogs with KCS.
Materials and methods: A total of 66 eyes from 33 dogs were evaluated. The eyes were divided into three equal groups: Negative control group, tacrolimus group (TG), and homologous platelet-rich plasma group (HPRPG). The animals were evaluated using the Schirmer's tear test-1 (STT-1), osmolarity test (OT), strip meniscometry test (SMT), tear film break-up test (TBUT), fluorescein test, lissamine green test (LGT), and cytological and histopathological analyses.
Results: In TG, there was a significant increase (p < 0.05) in the STT-1 and SMT values, and goblet cell count in the palpebral conjunctiva by the end of the study. In HPRPG, 36% (four dogs) received three applications, 55% (six dogs) received two applications, and 9% (one dog) received one application before the initial ocular signs improved. There was a significant decrease (p < 0.05) in the lymphocyte and neutrophil counts of the palpebral conjunctiva in HPRPG than in TG. Both groups showed equivalent improvements in TBUT, OT, and LGT values.
Conclusion: Tacrolimus 0.03% eye drops were more efficient than HPRP in increasing tear production and the number of goblet cells. However, injectable HPRP was more efficient than tacrolimus in decreasing the number of conjunctival inflammatory cells. Treatment with injectable HPRP requires an average of two to three applications, is safe and feasible, and can be used as a cheaper alternative or as an adjuvant to conventional treatment with topical immunosuppressants.
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