Tacrolimus therapy for circinate balanitis associated with reactive arthritis

Abstract

Background: Reactive arthritis is the current name for the clinical triad characterized by arthritis, urethritis, and conjunctivitis, which develops over the course of a month or more. In some patients, this clinical triad is accompanied by circinate balanitis and keratoderma on the palms and soles. Balanitis, in some cases, is refractory to conventional therapy and can be recurrent, becoming a therapeutic challenge.

Methods: A total of 4 clinical cases of male patients, with ages ranging from 21 to 36 years old, presented with arthritis, conjunctivitis, urethritis, and recurrent circinate balanitis, which developed over a period of 1 to 6 months. All patients were treated with corticosteroids and sulfasalazine. In addition, one was treated with ciprofloxacin; however, balanitis was resistant to treatment in 3 patients.

Results: As other treatments had failed, topical 0.1% tacrolimus was used, with excellent results, as the balanitis lesions were cleared during the first week of topical therapy.

Conclusion: We propose the complementary use of topical tacrolimus in cases of reactive arthritis associated with circinate balanitis.