Topical calcineurin inhibitors for atopic dermatitis
Examples
Generic Name Brand Name pimecrolimus Elidel tacrolimus Protopic Topical medications are applied directly to the skin. Tacrolimus is an ointment, and pimecrolimus is a cream. Both medicines are applied only to skin affected by atopic dermatitis.
How It Works
Calcineurin inhibitors block the inflammation process, which is part of the body's immune response. This can relieve itching and improve the rash of atopic dermatitis. They are a type of immunosuppressant, a medication that decreases the effects of your body's immune system.
Why It Is Used
Topical calcineurin inhibitors may be used when conventional treatment (such as with corticosteroids) is not possible or unsuccessful. Calcineurin inhibitors are used on sensitive skin, such as the face and eyelids, where corticosteroids are avoided. Calcineurin inhibitors are used for short-term treatment of moderate atopic dermatitis. Calcineurin inhibitors are used in people age 2 and older with a healthy immune system. Short-term treatment may be repeated with breaks in between.
How Well It Works
Studies have reported that when compared with a:
- Mild corticosteroid, using tacrolimus ointment for 3 weeks improved the symptoms of atopic dermatitis and the area affected in children with moderate to severe atopic dermatitis.1
- Midpotent to potent corticosteroid, using tacrolimus ointment 0.1% for 3 weeks resulted in similar improvement in symptoms in adults with moderate to severe atopic dermatitis. Tacrolimus ointment .03% also improved symptoms, but not as much as the corticosteroid or tacrolimus 0.1%.2
Side Effects
A common side effect of topical calcineurin inhibitors is a burning and itching that goes away after the first few days of treatment. Less common side effects include acne, headache, increased sensitivity of the skin to hot and cold temperatures, and flu-like symptoms.
Topical calcineurin inhibitors are relatively new, and long-term side effects are not fully known. Health Canada and the U.S. Food and Drug Administration (FDA) recommend caution when prescribing or using Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment because of a potential cancer risk. Rare cases of cancer have been reported in people using Elidel and Protopic. But a link between these medicines and cancer has not been shown.3 Health Canada and the FDA also stress that these medicines only be used as directed and only after trying other treatment options. Talk to your doctor about whether these products are right for you or your child.4
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
There is not adequate information on the use of calcineurin inhibitors in pregnant or breast-feeding women. Talk to your health professional if you are breast-feeding, pregnant, or planning to become pregnant.
Calcineurin inhibitors make your skin more sensitive to light. After using calcineurin inhibitors, avoid sunlight and sunlamps and treatment with ultraviolet light. If you need to be outside after using calcineurin inhibitors, wear loose-fitting clothing that protects the treated skin from the sun.
Unlike topical corticosteroid medication, topical calcineurin inhibitors do not thin the skin.
Calcineurin inhibitors are usually used in combination with preventive measures, such as moisturizing your skin and avoiding skin irritants.
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| Author: | Douglas Dana Robin Parks, MS | Last Updated: July 26, 2006 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Randall D. Burr, MD - Dermatology | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |