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Tacrolimus Ointment
Aka: Tacrolimus Ointment, Protopic, Elidel, Pimecrolimus
- Indications
- Severe refractory Atopic Dermatitis
- Pharmacokinetics
- Normal topical use causes <5 ng/ml serum concentration
- Greater absorption in severely damaged skin
- Factors increasing serum concentrations
- Higher doses or greater surface area of application
- Inflamed skin
- Mechanism
- Macrolide with similar activity to Cyclosporine
- Specifically binds T Cell receptors
- Inhibits Cytokine production
- Inhibits IgE sensitivity
- Precautions
- Increased risk of skin malignancy and Lymphoma
- FDA black box warning has been added
- Do not use for extended periods of time
- Use only in refractory Eczema
- Preparations
- Pimecrolimus (Elidel)
- Tacrolimus (Protopic)
- Dosing: Tracolimus
- Children over age 2 years: Apply 0.03% ointment bid
- Adults: Apply 0.03% or 0.1% ointment bid
- Adverse Effects
- Local irritation (transient <1 week)
- Burning
- Erythema
- Pruritus
- Less common adverse effects
- Skin Tingling
- Acne
- Hyperesthesia
- Alcohol intolerance
- Immunosuppression related adverse effects
- Varicella zoster increased Incidence
- Eczema herpeticum
- Increased malignancy risk in mice (see precautions)
- Skin cancer
- Lymphoma
- Precautions
- Protect treated areas from direct sunlight
- Systemic Tacrolimus associated with skin cancer
- Non-Melanoma skin cancer
- Advantages
- Very effective in refractory atopic cases
- Unlike Corticosteroids, does not cause skin atrophy
- May be useful on face and neck
- Disadvantages
- Expensive (costs per Red Book)
- Tacrolimus Ointment (0.03 or 0.1%): $60 per 30 grams
- Risk of malignancy (see prcautions)
- Skin cancer
- Lymphoma
- References
- Bekersky (2001) J Am Acad Dermatol 44:S17 [PubMed]
- Hanifin (2001) J Am Acad Dermatol 44:S28 [PubMed]
- Kang (2001) J Am Acad Dermatol 44:S58 [PubMed]
- Paller (2001) J Am Acad Dermatol 44:S47 [PubMed]
- Ruzicka (1997) N Engl J Med 337:816 [PubMed]
- (2001) Med Lett Drugs Ther 43(1102):33-34 [PubMed]