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Paradoxic eczema in infants after heart transplantation
Author(s) -
Jackson Cullison Stephanie R.,
Siegfried Elaine C.
Publication year - 2017
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.13342
Subject(s) - medicine , tacrolimus , psoriasis , transplantation , regimen , calcineurin , systemic antibiotics , heart transplantation , dermatology , intensive care medicine , surgery , antibiotics , microbiology and biotechnology , biology
New‐onset psoriasis in patients receiving tumor necrosis factor inhibitors is well recognized in children and adults. We describe three children who underwent cardiac transplantation and developed an analogous form of paradoxic eczema occurring 2‐48 months after starting systemic tacrolimus, a drug widely used topically to treat eczema. Anecdotal reports and our experience suggest that tacrolimus taper with alternative systemic antirejection immunosuppressant may lead to skin clearance. Pending additional insight, treatment should include optimizing skin barrier function, minimizing microbial and allergic triggers, and coordinating care to choose the best‐tolerated systemic immunosuppressant regimen at the lowest effective dose.