From the Guidelines
Tacrolimus ointment is a recommended treatment for chronic eczema (atopic dermatitis) when topical corticosteroids are not effective or for sensitive areas, as it reduces inflammation and itching without causing skin thinning.
Treatment Details
- It comes in two strengths: 0.03% for children aged 2-15 years and 0.1% for adults, applied thinly twice daily to affected areas 1.
- Most patients see improvement within 1-2 weeks, and treatment can continue for 6-12 weeks for acute flares, with intermittent use for maintenance therapy.
- Tacrolimus works by suppressing the immune response in the skin by inhibiting calcineurin, which reduces inflammation and itching without causing skin thinning like steroids.
Side Effects and Precautions
- Common side effects include temporary burning or stinging sensation upon application, which typically diminishes with continued use.
- Patients should avoid sun exposure and use sunscreen when using tacrolimus, as it may increase sensitivity to UV light.
- While generally safe for long-term use, tacrolimus should be used at the lowest effective dose for the shortest duration needed to control symptoms.
Evidence Support
- The most recent and highest quality study supports the use of tacrolimus ointment for chronic eczema, with a study from 2022 providing guidance on its use in pediatric patients 1.
- Other studies, such as those from 2009 and 2014, also support the effectiveness of tacrolimus ointment in reducing inflammation and itching in patients with atopic dermatitis 1.
From the Research
Efficacy of Tacrolimus for Chronic Eczema
- Tacrolimus ointment has been shown to be effective in treating moderate to severe atopic dermatitis, with significant improvements in physician's global evaluation of clinical response and quality of life 2, 3, 4.
- Studies have demonstrated that tacrolimus 0.1% is more effective than the 0.03% concentration, and is well tolerated for up to 2 years 2.
- Network meta-analyses have ranked tacrolimus 0.1% among the most effective treatments for improving patient-reported symptoms and clinician-reported signs, with moderate confidence 5, 6.
Safety of Tacrolimus for Chronic Eczema
- The most common adverse events associated with tacrolimus ointment are skin burning and pruritus, which are generally mild and transient 2, 3, 4.
- Local application site reactions are more common with tacrolimus 0.1% and crisaborole 2%, while skin thinning is not increased with short-term use of any topical steroid potency, but may be increased with longer-term use 5, 6.
- Serious adverse events are rare and are considered to be unrelated to the treatment 4.
Comparison with Other Treatments
- Tacrolimus 0.1% has been shown to be more effective than low-potency topical corticosteroids and pimecrolimus 1% 4, 5.
- Potent topical steroids, Janus kinase inhibitors, and tacrolimus 0.1% are consistently ranked among the most effective topical anti-inflammatory treatments for eczema 5, 6.
- Tacrolimus 0.03% is superior to mild topical corticosteroids and pimecrolimus 1% for some outcomes, but the evidence is limited by the lack of data 4, 5.