Cyclosporine Shampoo Availability
No, there is no cyclosporine shampoo formulation available or approved for treating skin conditions such as psoriasis or atopic dermatitis. Cyclosporine is only available as oral formulations (soft gelatin capsules) for dermatologic use, and topical cyclosporine formulations have proven ineffective. 1
Why Topical Cyclosporine Doesn't Work
Topical cyclosporine formulations have failed to demonstrate clinical efficacy in controlled studies, with response rates of 50% or less in humans, and no significant improvement found in patients with atopic dermatitis or allergic contact dermatitis. 2
The molecular properties of cyclosporine make topical delivery problematic—it is a neutral, hydrophobic, cyclic polypeptide with a molecular weight of 1203 Da, which limits skin penetration. 1
Available Cyclosporine Formulations
Cyclosporine is only available in oral formulations for dermatologic conditions:
Microemulsion formulation (Neoral): The preferred formulation with more rapid absorption, consistent bioavailability, and faster onset of action compared to the original formulation. 3, 4
Original formulation (Sandimmun): An olive oil-based solution with lower and more variable bioavailability, now largely superseded by the microemulsion. 1
Both formulations come as soft gelatin capsules taken orally, divided into two doses daily. 1, 4
Approved Dermatologic Uses
Cyclosporine oral therapy is FDA-approved and highly effective for:
Severe chronic plaque psoriasis: Achieving 50-70% PASI 75 response at 2.5-5 mg/kg/day within 8-16 weeks. 5
Severe refractory atopic dermatitis: Dosed at 3-5 mg/kg/day for adults with disease uncontrolled by optimized topical treatments and phototherapy. 6
The drug is reserved for severe disease as a second-line agent due to its narrow therapeutic index and risks of nephrotoxicity and hypertension. 1
Critical Safety Limitations
Oral cyclosporine requires intensive monitoring and has significant restrictions:
Maximum FDA-approved duration is 1 year of continuous treatment, with short-term intermittent courses (8-16 weeks) strongly preferred. 4, 5
Mandatory monitoring includes blood pressure and serum creatinine every 2 weeks for the first 3 months, then monthly. 4, 6
Nephrotoxicity occurs in up to 71% of patients on long-term therapy, and hypertension develops in 40-57% of patients. 6, 5
Common Pitfall to Avoid
Do not confuse cyclosporine with tacrolimus—while topical tacrolimus (Protopic) is well-established and effective for atopic dermatitis, topical cyclosporine formulations remain ineffective and unavailable. 7 If a patient needs topical calcineurin inhibitor therapy, prescribe tacrolimus ointment, not cyclosporine.