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Topical medicines are put directly on 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 medicine 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.
Both pimecrolimus and tacrolimus have been shown to be effective for use in atopic dermatitis. Most patients have much less itching within 3 days of starting treatment, and they feel much better.1
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 recommends caution when prescribing or using pimecrolimus cream and tacrolimus ointment because of a potential cancer risk. Rare cases of cancer have been reported in people using pimecrolimus and tacrolimus. Health Canada also stresses that these medicines only be used as directed and only after trying other treatment options.2 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 doctor 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 medicine, 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.
- American Academy of Allergy, Asthma and Immunology (2004). Disease management of atopic dermatitis: An updated practice parameter. Annals of Allergy, Asthma and Immunology, 93: S1–S28. Available online: http://www.aaaai.org/professionals/resources/pdf/atopic_derm2004.pdf.
- Health Canada (2005). Advisory: Safety information about Elidel cream and Protopic ointment. Available online: http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2005/2005_31_e.html.
Last Revised: April 18, 2012
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