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Topical Immunomodulators (Topical Calcineurin Inhibitors )

  • Pimecrolimus 1% Cream (Elidel®)
  • Tacrolimus .1% and 0.03% ointment (Protopic®)

Pimecrolimus 1% Cream (Elidel®)

Elidel is a topical calcineurin inhibitor approved in Canada in March 2003, and is indicated for short-term intermittent long term therapy of mild to moderate atopic dermatitis. It is to be used in patients older than 2 years who are not immunocompromised where conventional therapy is thought not appropriate or ineffective.

As Elidel is a non-steroid medication with proven efficacy to provide relief of itch, rash & redness, and is the only eczema treatment proven by studies to reduce flares over time & increase the time to the next flare. As well, studies have demonstrated safety in infants, children and adults. This drug is well absorbed into the skin but not into the blood stream. A burning sensation may occur initially in some users. However, the cream formulation makes it attractive for use on the face, with children, or when an ointment is in appropriate.

One of the advantages of utilizing Elidel is that it is the only eczema medication proven to reduce both the frequency and intensity of flares in both children and adults. It also has been demonstrated to reduce the use of steroids over the long term.

Pimecrolimus effective in the long term management of mild to moderate eczema:

Pimecrolimus efficacy in both children & adults

Pediatrics 2002;110(1):1-8 and Dermatology 2004;208:365-372

Pimecrolimus reduces the incidence of flares and reduces steroid use

Dermatology 2004;208:365-372

Pimecrolimus: an important eczema treatment option

J Allergy Clin Immunol 2003;vol 112; no 6:S140-150

Tacrolimus .1% and 0.03% ointment (Protopic®):

This is a new generation of topical immunomodulating agents. It is a calcineurin inhibitor which in turn inhibits the activity of white blood calls called T lymphocytes which produce a cascade of chemicals that increase inflammation The drug has been studied in both children and adults and has been shown to be effective. It is a non-steroid. The most common side effect is of transient burning. It appears to be safe for long term use.

Marked to excellent improvement was seen in moderate to severe eczema in the majority of patients using Tacrolimus 0.1% ointment over a one year period Arch Dermatol 2000; 136:999-1006

Where and when should it be used?

  • This drug is licensed for eczema
  • “Who have failed to respond adequately to conventional therapy”
  • In practice it is being used often as first treatment

Where to use?

It is a reasonable drug to use alone paticularly in areas of high risk of skin thinning with cortisones including face,eyelids, groin, folds, as well as the upper chest.

When should it be used?

This drug clearly is ideal for those with "topical steroid phobias". It could be used alone or combined with a corticosteroid. It could be used after the corticosteroids have reduced the flare of eczema to prevent future flares. Tacrolimus is certainly more expensive than the most commonly used corticosteroids and may be important for some patients.

Studies of Efficacy in Eczema Tacrolimus vs Topical Cortisone

Tacrolimus more effective than 1% Hydrocortisone (weak)
J Allergy Clin Immunol 2002;109:539-546

Tacrolimus equally effective to Betamethasone valerate (medium)
Nishinihon J Derm 1997:59:870-879

Tacrolimus equally effective to Hydrocortisone butyrate (medium)
J allergy Clin Immunol 2002; 109:547-555