Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Study Letter
88 (
); 247-249

Tacrolimus as a therapeutic alternative in psoriasis: A retrospective observational study

Department of Dermatology,Military Hospital, Agra, Uttar Pradesh, India
Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
Corresponding author: Dr. Shekhar Neema, Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Baveja S, Neema S, Pathania V, Kothari R. Tacrolimus as a therapeutic alternative in psoriasis: A retrospective observational study. Indian J Dermatol Venereol Leprol 2022;88:247-9.


Psoriasis vulgaris is a chronic inflammatory condition affecting 1–3% of the general population. The commonly used systemic agents for psoriasis are methotrexate, cyclosporine, acitretin, phototherapy and biologics. Cyclosporine is a well-studied and rapidly acting drug in psoriasis.1 Tacrolimus has a similar mechanism of action to cyclosporine on pathogenic T cells. However, it is 100 times more potent inhibitor of T-cell activation and has fewer adverse effects in renal transplantation patients as compared to cyclosporine.2 Its use in psoriasis is not studied extensively. We conducted a retrospective analysis of seven patients in the department of dermatology at a tertiary care centre in West Maharashtra, who were administered oral tacrolimus during the period June 2019 through December 2019. Patients with moderate-to-severe chronic plaque psoriasis [psoriasis area and severity index (PASI) score >10] who failed first-line therapy (less than 50% improvement in baseline PASI after at least three months of treatment) or presented in erythroderma or pustular psoriasis were administered tacrolimus. The patients with renal/hepatic disease, uncontrolled hypertension, acute/chronic infection, immunodeficiency states, seizure disorders, diabetes, malignancy and pregnant/lactating women were excluded from the study. Capsule tacrolimus was administered in a dose of 0.1 mg/kg/day and all the study patients were followed up at one, four and 12 weeks. PASI, body surface area and any adverse effects of the medication were noted. Investigations performed are tabulated in Table 1. Alternative treatments were offered to patients who did not tolerate or had a suboptimal response after four weeks of therapy.

Table 1:: Investigations performed in patients
Timeline Investigations
Baseline Blood pressure, blood urea, serum creatinine, lipid profile, blood sugar fasting and post prandial, complete blood count, serology for hepatitis B, C and HIV, chest X-ray and tuberculin skin test, serum bilirubin, SGOT, SGPT, urine routine and microscopic examination
One week Blood pressure, serum tacrolimus trough level
Two weeks Blood pressure, serum creatinine
Four weeks Blood pressure, blood urea, serum creatinine, blood sugar fasting and postprandial, lipid profile
Eight weeks Blood pressure, serum creatinine
12 weeks Blood pressure, blood urea, serum creatinine, blood sugar fasting and postprandial, lipid profile, serum bilirubin, SGOT, SGPT

A total of seven patients including four males and three females were administered the drug during the study period. The median age of the patients and duration of psoriasis were 60 years (interquartile range: 54–64 years) and nine years (interquartile range: 1–22), respectively. The median PASI at baseline was 39 (interquartile range: 13–48). At 12 weeks, six (85.7%) patients achieved PASI 75 and five (71%) patients achieved PASI 90 response [Figure 1], one (14.3%) showed PASI 75 response and one did not reach PASI 50 and was considered a failure. The patient who failed treatment was managed with secukinumab. Details of baseline characteristics and response at various timelines are presented in Table 2. The most common side effects experienced were diarrhoea and vomiting in three (43%) and impaired glucose tolerance in one (14.3%) patient, which normalised in a week. Serum tacrolimus trough levels at day six were within normal limits for all the patients.

Table 2:: Baseline disease, previous treatment, response to treatment and adverse effect profile in patients treated with tacrolimus
S. No. Age Sex Duration Disease Previous treatment ADR Serum tacrolimus level (normal levels: 5-15 ng/ml) PASI
Baseline Four weeks 12 weeks
1 60 F 1 Erythroderma MTX, CsA Diarrhoea 5.62 39 0 0
2 54 M 9 CPP MTX, phototherapy Nil 7.18 10.9 6 5
3 64 F 34 CPP MTX, acitretin Vomiting 5.68 23.6 26 5.2
4 30 F 1 Erythroderma MTX Diarrhoea 6.8 48.2 0 0
5 65 M 22 Pustular psoriasis MTX, acitretin, phototherapy, CsA Nil 6.2 44.6 0 0
6 62 M 10 CPP MTX, phototherapy, acitretin, CsA Impaired glucose tolerance 6.78 13 1.2 0.8
7 59 M 6 Erythroderma MTX, CsA Nil 8.2 50.7 37.4

CPP: Chronic plaque psoriasis; ADR: adverse drug reactions; MTX: Methotrexate; CsA: Cyclosporine A; PASI: psoriasis area and severity index

Figure 1:: (a) a case of psoriatic erythroderma involving more than 90% body surface area (b) Significant improvement at 4 weeks

Tacrolimus is used less commonly for dermatological indications as compared to cyclosporine because of factors such as cost and less experience of dermatologists with this drug, while nephrologists have largely shifted to tacrolimus for post-renal transplant patients due to better efficacy and safety. Nikolaidis et al. used 0.3 mg/kg of oral tacrolimus for four weeks in severe psoriasis; all the patients achieved remission but developed raised serum creatinine.3 This may be because of the higher dosage used as compared to our study. Jegasothy et al. used oral tacrolimus in seven patients with psoriasis including four post-transplant patients in a dose of 0.016 mg/kg for three weeks. All the patients achieved remission.4 A study by European FK506 multicentre psoriasis study group in which 70% or more reduction in PASI was seen in 12/19 (63.2%) patients at nine weeks with dose ranging from 0.05 to 0.15 mg/kg/ day.5 We used 0.1 mg/kg in our patients and PASI 75 was seen in 6/7 (85.7%) patients. The better response may be due to higher dosage and longer follow-up period in our study. Mittal et al. reported PASI 75 in 19/26 (73.1%) of patients and PASI 90 in 11/26 (42.3%) patients at a dose of 0.1 mg/kg at 12 weeks.6 In our study, higher percentage of patients achieved PASI 75 ([6/7] 85.7%) and PASI 90 ([5/7]71%) at 12 weeks. This difference may be due to different patient profile. None of the patients developed severe side effects in the study by Mittal et al. which was similar to our study.

Oral tacrolimus in the dose of 0.1 mg/kg is safe and effective for the short-term management of severe or recalcitrant forms of psoriasis and can serve as an alternate to the conventionally used cyclosporine for rapid control of the disease. Higher cost and narrow therapeutic index requiring blood level monitoring are the disadvantages of using tacrolimus over cyclosporine. Further studies with more sample size and longer follow-up period would be required to understand the long-term remission and recurrence rates.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , , , , , et al. Cyclosporine in severe psoriasis, Results of a meta-analysis in 579 patients. Am J Clin Dermatol. 2001;2:41-7.
    [CrossRef] [PubMed] [Google Scholar]
  2. . Mechanisms of action of new immunosuppressive drugs. Kidney Int Suppl. 1996;53:S26-38.
    [Google Scholar]
  3. , , , , , , et al. Metabolic effects of FK 506 in patients with severe psoriasis: Short-term follow-up of seven cases. Transplant Proc. 1991;23:3325-7.
    [Google Scholar]
  4. , , , , , . Tacrolimus (FK 506)-a new therapeutic agent for severe recalcitrant psoriasis. Arch Dermatol. 1992;128:781-5.
    [CrossRef] [PubMed] [Google Scholar]
  5. Systemic tacrolimus (FK 506) is effective for the treatment of psoriasis in a double-blind, placebo-controlled study, The European FK 506 multicentre psoriasis study group. Arch Dermatol. 1996;132:419-23.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , . Pilot study to evaluate the efficacy and safety of oral tacrolimus in adult patients with refractory severe plaque psoriasis. J Cutan Med Surg. 2016;20:228-32.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections