What is the recommended dosing for Protopic (tacrolimus) in treating atopic dermatitis?

Protopic (Tacrolimus) Dosing for Atopic Dermatitis

For atopic dermatitis treatment, Protopic (tacrolimus) ointment should be applied twice daily at 0.03% strength for children (age 2-15 years) and 0.1% strength for adults (16+ years) until the affected area clears, followed by maintenance therapy twice weekly to prevent relapse.

Recommended Dosing by Age Group

Adults (16 years and older):

• Strength: 0.1% ointment
• Application frequency: Apply twice daily to affected areas
• Duration: Continue until clearance of lesions
• Maintenance therapy: Twice weekly application to previously affected areas to prevent relapse

Children (2-15 years):

• Strength: 0.03% ointment
• Application frequency: Apply twice daily to affected areas
• Duration: Continue until clearance of lesions
• Maintenance therapy: Twice weekly application to previously affected areas to prevent relapse

Application Instructions

• Apply a thin layer to affected skin areas only
• Gently rub in completely
• Can be used on all body areas, including face, neck, and sensitive skin areas where corticosteroids might cause adverse effects 1
• Wash hands after application unless hands are being treated

Efficacy Considerations

• Tacrolimus ointment is particularly effective for head and neck atopic dermatitis, which is often therapeutically challenging 2
• Studies show that 0.03% tacrolimus is significantly more efficacious than 1% hydrocortisone acetate in children with moderate to severe atopic dermatitis 3
• The 0.1% formulation provides greater improvement compared to the 0.03% formulation in adults 4

Safety Profile

• Most common side effects include transient application site burning and pruritus, which typically resolve within 3-4 days of starting treatment 3
• Unlike topical corticosteroids, tacrolimus ointment is not associated with skin atrophy, making it suitable for long-term treatment 5
• Systemic absorption is minimal and decreases with time 4
• Avoid use if there is clinical evidence of bacterial infection

Treatment Algorithm

1. Initial treatment phase:

   • Apply tacrolimus ointment twice daily to affected areas
   • Continue until clearance of lesions (typically 2-4 weeks)

2. Maintenance phase:

   • Once lesions clear, transition to proactive therapy
   • Apply tacrolimus ointment twice weekly to previously affected areas to prevent relapse 1

3. For inadequate response:

   • If no improvement after 2 weeks of proper application:
     • Rule out secondary infection
     • Consider alternative or adjunctive therapies
     • Consider systemic therapies or phototherapy for severe cases 1

Special Considerations

• Tacrolimus is particularly valuable for sensitive areas such as face, neck, and intertriginous regions where corticosteroids might cause adverse effects 5
• Avoid concurrent phototherapy due to theoretical risk of increased photocarcinogenicity 1
• Temporary skin burning sensation is common but typically resolves within days of starting treatment 3

Common Pitfalls to Avoid

• Undertreatment: Not applying enough ointment or stopping too soon
• Neglecting maintenance therapy: Failure to continue twice-weekly applications after clearance can lead to rapid relapse
• Ignoring skin barrier repair: Always combine with regular emollient use between tacrolimus applications
• Missing secondary infections: Consider antibiotics if there is evidence of bacterial infection