Actas Dermo-Sifiliográficas (English Edition) Actas Dermo-Sifiliográficas (English Edition)
Practical Dermatology
Practical Management of Immunosuppressants in Dermatology
Manejo práctico de inmunosupresores en dermatología
V.M. Leis-Dosil, , I. Prats-Caelles
Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
Received 18 December 2016, Accepted 14 May 2017

The treatment of inflammatory and autoimmune diseases is challenging because of their frequency and complexity. Treatment of these diseases is based on the suppression of the patient's immune system using corticosteroids, corticosteroid-sparing immunosuppressive agents, and biologic drugs, making an understanding of the management of immunosuppressive therapy essential. Before an immunosuppressive agent is prescribed, a study must be carried out to identify contraindications, detect latent infections, and determine the most appropriate dose. During treatment, regular monitoring is required to detect adverse effects. The clinician must be familiar with the time lag between start of treatment and onset of the immunosuppressive effect as well as the maximum recommended duration of treatment and cumulative dose for each drug. As dermatologists we are accustomed to using these immunosuppressive agents, but we should have a good knowledge of the guidelines for their use and the monitoring required in each case if we are to reduce variability and avoid potentially serious adverse effects.


Las enfermedades inflamatorias y autoinmunes constituyen un desafío terapéutico por frecuencia y complejidad. Su tratamiento se basa en la inmunosupresión del paciente con glucocorticoides, inmunosupresores ahorradores de corticoides y fármacos biológicos, siendo imprescindible por tanto conocer su manejo. Cuando se va a pautar un inmunosupresor es necesario realizar un estudio previo para detectar contraindicaciones, infecciones latentes o determinar la dosis más adecuada del fármaco. Durante el tratamiento se deben realizar controles periódicos para detectar efectos secundarios. Cada fármaco tiene un tiempo de inicio de acción que es preciso conocer, así como una duración o dosis acumulada máxima recomendada. Los dermatólogos estamos habituados al uso estos fármacos inmunosupresores, pero es necesario tener claras las pautas y los controles necesarios con cada uno, para disminuir la variabilidad y evitar efectos adversos potencialmente graves.

Methotrexate, Ciclosporin, Cyclophosphamide, Azathioprine, Mycophenolate, Immunosuppression
Palabras clave
Metotrexato, Ciclosporina, Ciclofosfamida, Azatioprina, Micofenolato, Inmunosupresión


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