What is ciclosporin?
Ciclosporin is an immunosuppressant drug that was originally used to prevent organ rejection in transplant patients. It was discovered in the 1970s and, like penicillin, is derived from a fungus. Its initial use in dermatology was in the treatment of psoriasis but it is also effective in the treatment of eczema.
How does ciclosporin work?
Ciclosporin works in eczema by inhibiting the production of inflammatory cytokines (chemicals that mediate inflammation). It is a potent immunosuppressant and starts to work rapidly (within 1–2 weeks). Further improvements can occur up to 12–16 weeks after the start of treatment.
When is ciclosporin used?
Ciclosporin is generally used for cases of severe persistent eczema that is unresponsive to topical treatments. It is currently licensed for use in people with severe eczema for whom conventional therapy is ineffective or inappropriate. It is used for a usual maximum duration of 8 weeks but may be used for longer under specialist supervision.
Ciclosporin can be used as a short-term off-licence treatment for children under the supervision of a consultant dermatologist.
It is available in the UK as capsules containing 10 mg, 25 mg, 50 mg and 100 mg of ciclosporin. A liquid preparation is also available. The dose of ciclosporin is usually calculated on body weight and is given in two divided doses. The usual dose recommended for adults is 2.5 mg/kg to 5 mg/kg daily. Eczema can flare quickly on withdrawal of ciclosporin and for this reason it is best to reduce the dose slowly. Doctors will often recommend switching to alternate-day treatment, then every third day. More potent topical treatments may be introduced to tide over the transition.
Who should NOT take ciclosporin?
People who have not had chicken pox must be vaccinated against chicken pox at least 3 months before starting treatment.
You should not take ciclosporin if you have severe kidney disease or hypertension (high blood pressure) as ciclosporin can make these conditions worse. It should also be avoided in people with a history of cancer or severe infection such as tuberculosis since the degree of immune suppression caused by ciclosporin may make the body less effective at fighting these conditions.
Ciclosporin has been used in pregnancy without complication, but evidence is limited and it is generally best avoided. If you are planning a family soon or if you become pregnant while taking ciclosporin, you should discuss this with your doctor straight away.
You should not breastfeed while taking ciclosporin.
What are the side effects of ciclosporin?
The main side effects of ciclosporin are hypertension (high blood pressure) and reduced efficiency of the kidneys (renal toxicity). Side effects are more likely to occur with higher doses. Blood pressure and kidney function need to be checked prior to treatment and monitored closely throughout treatment. Kidney function is usually checked using a blood test to measure a substance called creatinine, which is removed by the kidneys. Blood tests will usually be done every 3 months – more frequently at the start of treatment. If there are signs that your blood pressure or kidneys are being affected, the dose of ciclosporin will normally be reduced, or discontinued, and in most cases things will return to normal.
Because of its effect on the immune system, there is an increased risk of developing certain types of cancer with long-term ciclosporin treatment. The risk of bacterial, fungal and viral infection is also greater when you are on this medication. If you feel unwell, seek the advice of your doctor. You should also have an annual flu jab.
Other less serious but troublesome side effects include increased hair growth. This is a relatively common side effect and can be distressing.
You may experience swelling and enlargement of the gums, but this is usually a problem with higher doses.
Nausea, tremor (shaky hands) and altered sensation (pins and needles) can also be a problem.
Despite these side effects, for many people ciclosporin provides significant relief.
For more information on ciclosporin, please see our Ciclosporin factsheet