Safety and Efficacy of Topical Calcineurin Inhibitors in the Treatment of Facial and Genital Psoriasis: A Systematic Review

Facial and genital psoriasis impairs quality of life and is challenging to treat because of increased percutaneous penetration and, consequently, increased risk of adverse effects. Topical calcineurin inhibitors are recognized as a valid off-label treatment for these sensitive skin areas, but data on safety and efficacy are limited. This systematic review of the literature included 24 of 3,322 studies (5 randomized controlled trials, 9 open-label studies, 2 case series and 8 case reports). All studies demonstrated positive efficacy; 11 studies found statistically significant reductions in psoriasis severity. Local stinging, burning and itching were the most common short-term adverse effects and were reported in 18 studies. Topical calcineurin inhibitors appear to have an important role in the treatment of facial and genital psoriasis. The drugs are effective and generally well-tolerated with few adverse effects. SIGNIFICANCE Among patients with psoriasis, up to 29% develop facial psoriasis and 63% develop genital psoriasis. Facial and genital psoriasis impairs quality of life and because of the sensitive nature of these skin areas, treatment is challenging. Topical calcineurin inhibitors are recognized as a valid off-label treatment. This study systematically searched the literature to investigate whether this off-label treatment is safe and effective. This systematic review confirms that topical calcineurin inhibitors are safe and effective in treating facial and genital psoriasis.