Online Pharmacy Medicine Blog

When Protopic and Elidel ointments came on the market to treat eczema — particularly atopic dermatitis — they were viewed as an attractive alternative to steroid ointments.

Atopic dermatitis is a disease that can result in scales on the skin surface, red blotches, lesions, and oozing sores. It can vary greatly in severity, and as many 25 of the world’s population suffers from it to some degree, often starting in infancy or childhood.

For nearly 50 years, atopic dermatitis has been treated with topical corticosteroids. Unfortunately, not all patients respond to topical steroids, and others have unpleasant side effects. Additionally, long-term steroid use can cause thinning of the skin and other consequences.

That’s where Protopic (tacrolimus) and Elidel (pimecrolimus) entered the picture in 2000. Known as topical calcineurin inhibitors (TCIs), these drugs suppress inflammation in a similar way to steroids, but are steroid-free. As such, they can be prescribed for longer periods and be applied to thinner skin, such as on the face and eyelids. They also do not cause side effects such as pigment changes, blood vessel formation and striae formation, which can occur with steroids. They are gentler on the skin of small children.

But there are now questions about the safety of these drugs. The ointments were prescribed heavily by pediatricians and others until 2005, when the FDA slapped both drugs with a “black box” warning, as a result of reports of children and adults who developed cancer — such as skin cancers and lymphomas — while using these medications. Many researchers, allergists and dermatologists do not believe there is any proof of a causal link between these medications and cancer. However, the warnings are still in place.

Today, because of the possible cancer risk, among other considerations, Elidel and Protopic are considered a second line of treatment — after topical steroids — for atopic dermatitis in adults and children two years and older. In general, these medications should only be used for short-term bouts of eczema; over the long term, the best and safest approach is the liberal use of moisturizers to maintain good skin hydration.

As always, ask your doctor.