Topical Tacrolimus

Topical Tacrolimus - A Snapshot

Key points to know about a versatile non-steroidal topical anti-inflammatory agent commonly used in dermatology.

- Topical tacrolimus, available commercially in many countries as Protopic in two strengths, 0.03% and 0.1%, is a topical immunomodulating medication widely used in dermatology for its potent anti-inflammatory properties [1].

- It is not commercially available in Australia and must be compounded individually per prescription, per patient.

- Topical tacrolimus belongs to the class of drugs known as calcineurin inhibitors, specifically targeting T-cell activation and cytokine release [2]. Other agents in this class include pimecrolimus (Elidel).

- It offers the benefit of being compounded in an ointment base which can aid in hydration and skin penetration of the drug.

- Topical tacrolimus is primarily prescribed for the treatment of moderate to severe atopic dermatitis [3]. This use is well supported by numerous clinical trials that highlight significant efficacy in reducing inflammation and pruritus [4].

- Beyond its approved use, Topical tacrolimus is used by dermatologists off-label for treating other inflammatory skin conditions such as vitiligo, psoriasis, rosacea seborrheic dermatitis and periorifical dermatitis [5].

- A key benefit of tacrolimus is its non-steroidal nature, which reduces the risk of typical steroid-related side effects like skin thinning (cutaneous atrophy), ocular side effects and hypothalamic-pituitary-adrenal axis suppression [6].

- It is particularly useful for steroid-phobic patients to treat any area of the body, for eyelid dermatitis (and is used by ophthalmologist to treat intrkeratoconjunctivitis sicca), and for facial inflammatory dermatoses where potent topical steroids are otherwise contraindicated.

-  It is also seen used for hand dermatitis in exchange for topical steroids to eliminate the risk of inadvertent facial and ocular exposure of topical steroids (by way of inadvertent facial touching / rubbing).

-  Topical tacrolimus is typically applied to the affected areas of the skin twice daily. The duration of use can vary depending on patient response and condition severity, with no specific time limits reported on its use [7].

- Local side effects such as irritation at the application site is uncommon and typically resolves with continued use when it does occur.

- The safety of topical tacrolimus in pregnant or breastfeeding women has not been fully established and hence is contraindicated.

- Protopic, as it is available overseas, is approved for children aged two years and above, and provides a valuable treatment alternative for paediatric atopic dermatitis.

- Topical tacrolimus is an important agent in the management of several dermatological conditions. Its safety profile offers a significant benefit over traditional corticosteroids, particularly for long-term management and for facial dermatoses.