Health Library Topical Calcineurin Inhibitors for Atopic DermatitisFrom Healthwise

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.

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.

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.

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

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. The U.S. Food and Drug Administration (FDA) recommends 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 The FDA also stresses 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.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

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.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Citations

1. Reitamo S, et al. (2002). Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. Journal of Allergy and Clinical Immunology, 109(3): 539–546.
2. Reitamo S, et al. (2002). Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. Journal of Allergy and Clinical Immunology, 109(3): 547–555.
3. U.S. Food and Drug Administration (2006). FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. FDA News. Available online: http://www.fda.gov/bbs/topics/news/2006/NEW01299.html.

Author:	Maria G. Essig, MS, ELS	Last Updated: May 5, 2008
Medical Review:	Martin Gabica, MD - Family Medicine Anne C. Poinier, MD - Internal Medicine
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