Pp. 153-190 (38)
Alberto Conde-Taboada, Beatriz González-Sixto and Alicia Pérez Bustillo
In the last decade, new molecules with the ability to change the local immune
response of skin have appeared. The topical application of these medications enhance
(imiquimod) or reduce (tacrolimus, pimecrolimus) the inflammatory response of skin.
Imiquimod is a synthetic compound that is a member of the imidazoquinolone family of
drugs. This class of drugs has the properties of topical immune response modifiers and
stimulators. The mechanism of action of imiquimod involves cytokine induction in the
skin, which then triggers the host's immune system to recognize the presence of a viral
infection or tumor, ultimately to eradicate the associated lesion. Topical calcineurin
inhibitors (TCI), tacrolimus and pimecrolimus are immunomodulator macrolides that
block T cell activation in the skin. The therapeutic effects of calcineurin inhibitors are
mainly attributed to these effects on T cells. Tacrolimus and pimecrolimus belong to the
group of ascomycin derivates obtained from the fungus-like bacteria Streptomyces.
Tacrolimus was isolated from Streptomyces tsukubaensis and pimecrolimus is produced
by Streptomyces hygroscopicus. TCI are used for the management of atopic dermatitis
(AD) and have proven to be of benefit in the treatment of other dermatosis.
Imiquimod, adjunvant, immunologic, antineoplastic agents, interferon
inducers, tacrolimus, macrolides, immunosupressive agents, pimecrolimus, antiinflammatory
agents, Non-Steroidal, dermatologic agents, administration, topical,
Dermatology Department, Hospital Clínico San Carlos, Madrid, Spain