- Severe refractory Atopic Dermatitis
- 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
- Macrolide with similar activity to Cyclosporine
- Specifically binds T Cell receptors
- Inhibits Cytokine production
- Inhibits IgE sensitivity
- 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
- Pimecrolimus (Elidel)
- Tacrolimus (Protopic)
- Tracolimus
- Children over age 2 years: Apply 0.03% ointment bid
- Adults: Apply 0.03% or 0.1% ointment bid
- Local irritation (transient <1 week)
- Burning
- Erythema
- Pruritus
- Less common adverse effects
- Immunosuppression related adverse effects
- Increased malignancy risk in mice (see precautions)
- Protect treated areas from direct sunlight
- Systemic Tacrolimus associated with Skin Cancer
- Non-melanoma Skin Cancer
- Very effective in refractory atopic cases
- Unlike Corticosteroids, does not cause skin atrophy
- May be useful on face and neck
- Expensive (costs per Red Book)
- Tacrolimus Ointment (0.03 or 0.1%): $60 per 30 grams
- Risk of malignancy (see prcautions)