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September 2002

Significant Systemic Absorption of Tacrolimus After Topical Application in a Patient With Lamellar Ichthyosis

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Arch Dermatol. 2002;138(9):1259-1260. doi:10.1001/archderm.138.9.1251

Lamellar ichthyosis (LI) (Online Mendelian Inheritance in Man [OMIM] database No. 242300), usually inherited in an autosomal recessive fashion, is characterized by nonbullous erythroderma and scaling at birth, occasionally with a collodion membrane. Most individuals with LI express mutations in the gene encoding transglutaminase-1 (TGM1), which has been mapped to chromosome 14q11.2.1 These patients have a reduced barrier function with increased transepidermal water loss values.2 Their increased skin permeability may result in intoxication by cutaneous absorption of substances applied to the skin. Indeed, systemic salicylate toxic effects have been reported in a patient with LI after topical application.3 A recent report described 3 children with Netherton syndrome (OMIM 256500), a keratinizing disorder characterized by trichorrhesis nodosa, congenital ichthyosiform erythroderma, and an atopic diathesis, treated with 0.1% tacrolimus ointment who percutaneously absorbed a significant amount of the drug, but without adverse effects.4

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