Date - 03 February 2005

Source- Drugs in Context 2004; 1E(10): Tacrolimus ointment - Atopic eczema p370

Author - Dr Anna Palmer

Tacrolimus was developed in the 1990s as a topical immunomodulatory therapy for atopic eczema (alternatively termed atopic dermatitis). Tacrolimus was originally developed as a systemic immunosuppressant to prevent rejection of organ transplants, and continues to be used in this way. As a topical formulation, tacrolimus exhibits minimal systemic absorption and no system accumulation. This property ensures an excellent tolerability profile, with side-effects limited to mild local irritation. The most common adverse events are sensations of skin burning and itching and these symptoms tend to disappear as the skin heals, generally within a matter of days. Clinical trials conducted over the short- and long-term in both adults and in children aged over 2 years have shown that tacrolimus provides rapid and prolonged relief of the major symptoms of eczema (e.g. pruritus, erythema, oedema, induration/papulation, excoriations, lichenification and oozing or crusting). Tacrolimus was shown to be particularly effective in treating eczema of the head and neck. Moreover, other studies have demonstrated that skin atrophy is not induced with tacrolimus treatment. This represents an important advantage over traditional topical corticosteroid therapy, which can cause skin atrophy as a result of the inhibition of collagen synthesis. Consequently, topical corticosteroids must be used with caution in areas of thinner skin such as the face, neck and flexors and when applied over longer periods of time. Tacrolimus is available in two strengths of ointment (0.1 and 0.03%) licensed for twice-daily treatment of atopic eczema in adults and children. The 0.03% dose is licensed to treat both children over 2 years and adults, whilst the higher dose is reserved for adults only.

Keywords: Tacrolimus ointment, Atopic eczema