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The effects of cyclosporine on the immune system are discussed. This immunosuppressive drug is thought to work by inhibiting the proliferation of some types of T cells (a cell type of the immune system), while leaving the proliferation of other types unaffected. Conventional immunosuppressive drugs kill T cells that are proliferating, an action that can lead to permanent depletion of immunological memory. Cyclosporine, though, does not kill these cells (although it limits their rate of proliferation), and the patient's immunologic repertoire returns to normal if the drug is stopped. Immunosuppressive drugs are associated with an increased risk of cancer, perhaps because they activate latent oncogenic viruses (viruses that promote malignant change) or because they inhibit immunologic responses that arrest tumor growth. The experimental evidence for these hypotheses is reviewed. The effects of cyclosporine on cancer risk have been difficult to evaluate, since the drug has been most often given to transplant patients. Such patients receive so many immunosuppressive agents that the effects of any one drug cannot be determined. However, some studies implicate cyclosporine in elevating the risk for certain malignancies in these patients. When taken by patients with certain skin disorders (skin cancer, psoriasis), the drug appears to promote tumor development in cases of prior exposure to carcinogens. A discussion is presented of the effects on the immune system when cyclosporine is used to treat psoriasis, an increasingly common use of the drug. Whether cyclosporine will become the drug of choice for that disease depends on results from long-term studies that can assess the cancer risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

The drug cyclosporine is associated with significant side effects, which are reviewed in this report. Cyclosporine has been used with good results for treating psoriasis (a chronic inflammatory skin condition), alopecia areata (hair loss in defined areas), Behcet's disease (a chronic ulcerative condition), atopic dermatitis (skin inflammation with itching of no known origin), and lichen planus (reddish, scaly, itchy lesions), in addition to a host of autoimmune disorders (when the body manufactures antibodies against its own proteins). Patients who take cyclosporine require frequent monitoring to be sure that toxic levels have not been reached, and a list is presented of baseline tests that should be performed. Dosage considerations are reviewed, and drugs known to interact with cyclosporine are presented in tabular form. The principal side effects associated with use of cyclosporine for dermatologic conditions and conditions other than organ transplantation involve: the kidney and electrolyte balance system (kidney toxicity, changes in mineral balance, hypertension); the nervous system (headache, hand tremors, altered sensation in the extremities); digestive system (nausea, vomiting, loss of appetite, diarrhea); fat metabolism (increased blood lipid levels); gums (overgrowth); muscular and skeletal systems (joint pain, muscle aches); and skin (increased hair growth, infections of the hair follicles). Cyclosporine is also associated with a tendency to develop malignancies, effects on the fetus (although a pattern of abnormalities has not yet been described), and effects on the body as a whole (malaise, fatigue). In most cases, patients should be kept on the lowest dose possible that controls their symptoms. The discussion revolves around dosage effects and recommendations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Urticaria, or hives, develops when specific cells, known as mast cells, and T lymphocytes become activated and release certain substances (histamine, prostaglandins, leukotrienes, cytokines) that cause tissue inflammation. The result of this cellular response is the appearance of red, itchy bumps on the surface of the skin. Antihistamines are drugs that counteract the physiological effects of histamine, and they are used to treat patients with urticaria. Cyclosporine, a drug that is used to prevent tissue rejection in organ transplant patients, has been shown to prevent mast cells and T lymphocytes from releasing substances that cause inflammation. Therefore, a study was conducted to evaluate the usefulness of cyclosporine in treating severe idiopathic (of unknown cause) urticaria. Three patients with severe chronic urticaria, two of whom had angioedema in addition to urticaria, were assessed. After treatment with antihistamines had failed, the patients were treated with cyclosporine (6 milligrams per kilogram of body weight per day). Within one week of treatment, all symptoms of urticaria had disappeared. However, treatment with cyclosporine caused headaches, high blood pressure, nausea, fatigue, and tingling or pricking sensations. When the dose of cyclosporine was reduced to 3 milligrams (per kilogram per day), the side effects continued and the hives reappeared. Because of the side effects, treatment with cyclosporine was discontinued. When treatment was stopped the hives returned within 48 hours. It is concluded that cyclosporine is not an appropriate treatment for severe, chronic idiopathic urticaria and angioedema. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psoriasis is a chronic skin disease characterized by itching, redness, and plaque formation. The response of one type of psoriasis, generalized pustular or von Zumbusch psoriasis, to cyclosporine is described. This drug is commonly used as an immunosuppressive agent. The case study of a patient with a 30-year history of pustular psoriasis (in which small pimple-like structures form, then dry up and leave scabs) is presented. The patient's disease responded rapidly to cyclosporine; within 24 hours, improvement was noted, and pustules disappeared after three days. The optimal dose of the drug was determined over a period of several weeks. After four weeks, the patient developed high blood pressure, which was treated with another drug. Although other reports have demonstrated the effectiveness of cyclosporine against pustular psoriasis, this is the first case where relatively low doses (less than four milligrams per kilogram per day) led to remission. Lower doses can reduce the side effects associated with the drug. (Consumer Summary produced by Reliance Medical Information, Inc.)