COMBINATION OF TOPICAL TACROLIMUS AND ORAL DOXYCYCLINE IN MANAGEMENT OF STASIS DERMATITIS DUE TO CHRONIC VENOUS INSUFFICIENCY: A TERTIARY CARE CENTRE EXPERIENCE OF NELLOR, ANDHRA PRADESH.

Dr. CH. SAHITHI; Dr. UPENDRA CHOWDARY P

Volume : IX, Issue : V, May - 2020

COMBINATION OF TOPICAL TACROLIMUS AND ORAL DOXYCYCLINE IN MANAGEMENT OF STASIS DERMATITIS DUE TO CHRONIC VENOUS INSUFFICIENCY: A TERTIARY CARE CENTRE EXPERIENCE OF NELLOR, ANDHRA PRADESH.

Dr. Ch. Sahithi, Dr. Upendra Chowdary P

Abstract :

Background: Stasis dermatitis is common manifestation of Chronic venous insufficiency (CVI) in lower limb. The anti–collagenase, anti–inflammatory and immunomodulatory effects of doxycycline and the T–cell inhibitory effects of tacrolimus could theoretically modify the disease pathophysiology. This study was undertaken to evaluate the efficacy and safety of four weeks combination therapy of oral doxycycline 100 mg with topical tacrolimus 0.1% for stasis dermatitis associated with CVI. Methods: This study was conducted on subjects with CVI of C4 to C6 category (CEAP classification). Treatment duration was four weeks with fortnightly follow–ups. Primary efficacy was assessed as changes from baseline of pigmentation, erythema, edema, itching and hair loss of the affected area evaluated on Likert scale scores. Secondary efficacy parameters were percentage improvement of the dermatitis area and changes in ulcer dimensions (maximum length and eadth). Results: Out of 56 recruited subjects, 45 completed the study for analysis. Significant improvement in pain, edema, pigmentation, erythema and exudation were observed. Reduction of ulcer dimensions was also statistically significant. 91.1% showed improvement of the dermatitis area, 6.6% patients failed to show any improvement and 2.2% showed worsening. Adverse effects were observed in 3 patients and 1 patient had increased in exudation. Conclusions: This study suggests combination therapy of oral doxycycline and topical tacrolimus to be effective in reducing the symptoms and dermal manifestations of chronic venous insufficiency of leg but further studies are needed for validation.