From the Guidelines
For moderate to severe atopic dermatitis, tacrolimus (Protopic) ointment is recommended as a treatment option, with a strong recommendation for its use in adults, as stated in the guidelines of care for the management of atopic dermatitis in adults with topical therapies 1. The standard protocol involves applying a thin layer of 0.1% tacrolimus ointment to affected areas twice daily until symptoms resolve. Key points to consider when using tacrolimus ointment include:
- Treatment should continue for one week after clearing of symptoms to prevent relapse
- For maintenance therapy in patients with frequent flares, tacrolimus can be applied twice weekly to previously affected areas to prevent recurrence
- Tacrolimus works by inhibiting calcineurin, which suppresses T-cell activation and inflammatory cytokine production, reducing inflammation without causing skin atrophy like corticosteroids
- Patients should be advised that a burning sensation may occur upon initial application but typically subsides after a few days of use
- Sun protection is important during treatment as tacrolimus may increase photosensitivity
- Treatment should be temporarily discontinued during active infections at application sites, and patients should wash hands after application unless treating the hands themselves. It's worth noting that the most recent and highest quality study, published in 2023, provides strong evidence for the use of tacrolimus ointment in adults with moderate to severe atopic dermatitis 1.
From the Research
Treatment Protocol for Moderate to Severe Atopic Dermatitis
The recommended treatment protocol for moderate to severe atopic dermatitis using tacrolimus (Protopic) ointment involves the following:
- Application of 0.1% or 0.03% tacrolimus ointment, with the 0.1% formulation being more effective for moderate to severe cases 2, 3, 4
- Twice-daily application for 3 weeks or until clearance, with possible reduction to once-daily application after day 21 5
- Use of tacrolimus ointment as a second-line treatment for adults with facial eczema who have not responded to conventional treatment 5
Efficacy of Tacrolimus Ointment
The efficacy of tacrolimus ointment has been compared to other treatments, including:
- Topical corticosteroids: tacrolimus 0.1% ointment was found to be more effective than low-potency corticosteroids and similar in efficacy to moderate to potent corticosteroids 2, 3
- Pimecrolimus 1% cream: tacrolimus 0.1% ointment was found to be more effective than pimecrolimus 1% cream 2, 6
- Fluticasone 0.005% ointment: tacrolimus 0.1% ointment was found to be superior to fluticasone 0.005% ointment for the treatment of moderate to severe atopic dermatitis of the face 5
Safety and Tolerability
The safety and tolerability of tacrolimus ointment have been evaluated, with the following findings:
- Local application site irritations, such as skin burning and pruritus, are common adverse events, but tend to resolve with continued therapy 2, 3, 4
- No evidence of skin atrophy or increased risk of malignancies has been found with the use of tacrolimus ointment 2, 4
- Systemic absorption of tacrolimus from the ointment is minimal 4