Ciclosporin Side Effects — SCE Dermatology MCQ

Correct answer: C — Gingival hyperplasia

The correct answer is C, gingival hyperplasia. Ciclosporin has a well recognised profile of dermatological and mucocutaneous adverse effects, and alongside hypertrichosis, gingival overgrowth is one of the most consistently reported and clinically important, occurring in a substantial proportion of patients on long term therapy. Both effects relate to ciclosporin's action on fibroblast proliferation and connective tissue turnover, and gingival hyperplasia is further worsened by concurrent use of calcium channel blockers such as nifedipine or amlodipine, which are sometimes needed to manage ciclosporin induced hypertension. UK dermatology and rheumatology shared care guidance lists gingival hyperplasia as a common adverse effect requiring monitoring and dental hygiene advice. Recognising this pairing (hypertrichosis plus gingival hyperplasia) is a classic exam discriminator for ciclosporin toxicity. Why the other options are wrong: A. Alopecia: Ciclosporin characteristically causes hair growth (hypertrichosis) by prolonging the anagen phase, not hair loss, so alopecia is the opposite of its typical effect. B. Nail dystrophy: This is not a recognised or common ciclosporin adverse effect; nail changes are more typical of drugs like retinoids or in psoriasis itself, not ciclosporin therapy. E. Psoriasiform eruption: Drug induced psoriasiform eruptions are associated with beta blockers, lithium and anti-TNF agents, not ciclosporin, which is actually used to treat psoriasis rather than provoke it. D. Vitiligo: Vitiligo is an autoimmune depigmentation disorder with no established causal link to ciclosporin; ciclosporin is in fact sometimes used therapeutically in vitiligo related autoimmune contexts, not as a cause. Key point: Ciclosporin's mucocutaneous signature is hypertrichosis plus gingival hyperplasia, both reflecting its effect on fibroblast and connective tissue proliferation, worsened by concomitant calcium channel blockers.

Reference: NHS Humber and North Yorkshire Formulary, Ciclosporin (Rheumatology and Dermatology) Shared Care Guideline: common adverse effects include gingival hyperplasia; BNF Ciclosporin, side effects section (bnf.nice.org.uk)