Tacrolimus ointment (Protopic)

• the first in a new class of topical immunomodulators licensed to treat moderate-to-severe atopic eczema in adults and children who are not adequately responsive to or are intolerant of conventional therapies
• however it can be used as first-line therapy when there is extensive facial or periocular involvement or pigmented skin (1)
• tacrolimus ointment may be initiated by GPs if they have experience in managing patients on topical immunomodulatory therapy, such as topical corticosteroids (1)
• a review (1) concluded that tacrolimus ointement would appear to be a useful second-line agent for the treatment of atopic eczema
  • the selective mode of action of tacrolimus ointment results in effective treatment for moderate-to-severe atopic eczema with a good safety profile
• a Drug and Therapeutics review (2) states that tacrolimus ointment is as effective as topical steroids in the treatment of moderate-to-severe atopic dermatitis
  • concludes that short-term studies have established the efficacy of tacrolimus ointment in children and adults with atopic dermatitis
  • also concluded that it is an effective topical treatment, appropriate for use under the guidance of a specialist
  • tacrolimus can be used on areas of thin skin, such as the face and flexures, where avoidance of potent topical steroids is desirable
  • the 0.03 per cent formulation is licensed for use in children and is more effective than less potent steroids, such as 1 per cent hydrocortisone acetate
  • the 0.1 per cent formulation is licensed for use in the over-16s and is as effective as potent steroids, such as 0.1 per cent hydrocortisone butyrate
• a commentary by Dr Berth-Jones, Consultant Dermatologist in the UK, compared tacrolimus and pimecrolimus (3)
  • "tacrolimus is more potent than pimecrolimus"
  • .."while tacrolimus seems likely to be used mainly in the treatment of moderate and severe atopic eczema, pimecrolimus is likely to prove most useful in mild disease and when used to suppress further flares of eczema once the condition has been brought under control with topical steroids"
  • "both compounds are initially applied twice daily, but with tacrolimus it is often possible to reduce the frequency of application after a week or two"
  • "tacrolimus is available in two concentrations: 0.03 per cent for children and 0.1 per cent for adults"
  • "..like corticosteroids, application of the new immunomodulators is generally best avoided on infected skin, including areas affected by warts or molluscum"

Reference:

1. Prescriber (2003): 14 (9): 53-58.
2. Drug and Therapeutics Bulletin (2002); 40:73-5.
3. Prescriber (2004); 15 (10): 57-61.