Reactions 1459 - 6 Jul 2013 ★ S Ciclosporin/clobetasol Adrenal insufficiency and black dot tinea capitis (first report with ciclosporin): case report A 63-year-old man who had received clobetasol, and subsequently ciclosporin, developed black dot tinea capitis; clobetasol had also contributed to adrenal insufficiency. The man, who had a history of psoriasis, presented with hair loss and scalp pruritus. He had had long-standing use of superpotent steroid treatment with topical 0.05% clobetasol ointment [amount and frequency not stated], which had contributed to adrenal insufficiency with undetectable morning cortisol levels [duration of treatment to reaction onset not stated]. One month before presentation, his treatment had been switched to ciclosporin [dosage and route not stated]. Upon examination, he had diffuse alopecia with follicularly- based adherent black dots, background erythema and scale admixed with erythematous papules and plaques. The man initially received a 0.05% clobetasol solution on a small area of his scalp for pruritus. Subsequently, a potassium hydroxide preparation of the black dots showed endothrix and numerous demodex mites, and demodex infestation was diagnosed. He received terbinafine, and continued to receive ciclosporin. At last follow-up, he was in complete remission, with no clinical signs of alopecia, papules, pustules, erythema or scale. Author comment: "The patient’s prolonged use of superpotent corticosteroids led to hypothalamus-pituitary- adrenal axis suppression. This, in conjunction with cyclosporine treatment, provided a favorable environment for dermatophyte and Demodex growth." Yoo JY, et al. Black dot tinea capitis in an immunosuppressed man. Journal of Clinical and Aesthetic Dermatology 6: 49-50, No. 5, May 2013. Available from: URL: http://www.jcadonline.com/ - USA 803089432 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of black dot tinea capitis associated with ciclosporin. The WHO ADR database did not contain any reports of tinea capitis associated with ciclosporin. 1 Reactions 6 Jul 2013 No. 1459 0114-9954/10/1459-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Ciclosporin/clobetasol

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Reactions 1459 - 6 Jul 2013

★ SCiclosporin/clobetasol

Adrenal insufficiency and black dot tinea capitis(first report with ciclosporin): case report

A 63-year-old man who had received clobetasol, andsubsequently ciclosporin, developed black dot tinea capitis;clobetasol had also contributed to adrenal insufficiency.

The man, who had a history of psoriasis, presented with hairloss and scalp pruritus. He had had long-standing use ofsuperpotent steroid treatment with topical 0.05% clobetasolointment [amount and frequency not stated], which hadcontributed to adrenal insufficiency with undetectablemorning cortisol levels [duration of treatment to reaction onsetnot stated]. One month before presentation, his treatment hadbeen switched to ciclosporin [dosage and route not stated].Upon examination, he had diffuse alopecia with follicularly-based adherent black dots, background erythema and scaleadmixed with erythematous papules and plaques.

The man initially received a 0.05% clobetasol solution on asmall area of his scalp for pruritus. Subsequently, a potassiumhydroxide preparation of the black dots showed endothrix andnumerous demodex mites, and demodex infestation wasdiagnosed. He received terbinafine, and continued to receiveciclosporin. At last follow-up, he was in complete remission,with no clinical signs of alopecia, papules, pustules, erythemaor scale.

Author comment: "The patient’s prolonged use ofsuperpotent corticosteroids led to hypothalamus-pituitary-adrenal axis suppression. This, in conjunction withcyclosporine treatment, provided a favorable environment fordermatophyte and Demodex growth."Yoo JY, et al. Black dot tinea capitis in an immunosuppressed man. Journal ofClinical and Aesthetic Dermatology 6: 49-50, No. 5, May 2013. Available from:URL: http://www.jcadonline.com/ - USA 803089432

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of black dottinea capitis associated with ciclosporin. The WHO ADRdatabase did not contain any reports of tinea capitis associatedwith ciclosporin.