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Topical Use of Mammalian Target of Rapamycin (mTOR) Inhibitors in Tuberous Sclerosis Complex—A Comprehensive Review of the Literature

  • Sergiusz Jóźwiak
    Affiliations
    Department of Pediatric Neurology, Warsaw Medical University, Warsaw, Poland

    Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
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  • Krzysztof Sadowski
    Correspondence
    Communications should be addressed to: Dr. Sadowski; Department of Neurology and Epileptology; The Children's Memorial Health Institute; 04-730, Warsaw, Poland.
    Affiliations
    Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
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  • Katarzyna Kotulska
    Affiliations
    Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
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  • Robert A. Schwartz
    Affiliations
    Department of Dermatology, Rutgers University, New Jersey Medical School, Newark, New Jersey

    Department of Pediatrics, Rutgers University, New Jersey Medical School, Newark, New Jersey

    Department of Preventive Medicine and Community Health, Rutgers University, New Jersey Medical School, Newark, New Jersey

    Rutgers University School of Public Affairs and Administration, Newark, New Jersey
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      Abstract

      Background

      Tuberous sclerosis complex is a genetically determined multisystem disorder that may affect almost any human organ. The discovery of the mammalian target of rapamycin (mTOR) pathway and its involvement in tuberous sclerosis complex–related pathology has led to the introduction of mTOR inhibitors into clinical practice. Topical administration of mTOR inhibitors for skin lesions related to tuberous sclerosis complex may represent a reasonable alternative for more invasive procedures. A growing number of patients have been described exhibiting positive therapeutic effects from the topical administration of these agents. The aim of this review was to systematically analyze available literature on the use of topical mTOR inhibitors to treat dermatologic lesions related to tuberous sclerosis complex.

      Results

      A comprehensive review of PubMed, Medscape, and Cochrane databases between 1995 and 2015 was performed to identify available studies describing topical use of mTOR inhibitors in individuals with tuberous sclerosis complex. In most studies, topical mTOR inhibitor application proved to be effective in the treatment of skin lesions related to tuberous sclerosis complex. Facial angiofibromas were the target lesions in most instances. Few studies reported clinical improvement of hypomelanotic macules. These drugs directly address the molecular defect related to tuberous sclerosis complex manifestations.

      Conclusions

      Currently available clinical data suggest that topical application of mTOR inhibitors may be effective in the treatment of facial angiofibromas associated with tuberous sclerosis complex. Ongoing randomized clinical trials of topical mTOR inhibitors for TSC-related cutaneous lesions should add clarity to the role of these agents.

      Keywords

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