What is the role of Tacrolimus (FK506) in treating facial atopic dermatitis (eczema)?

From the Guidelines

Tacrolimus ointment is a recommended treatment for facial eczema, particularly for adults and children over 2 years old, due to its effectiveness in reducing inflammation and minimizing the risk of skin thinning associated with topical steroids. The most recent and highest quality study, 1, published in 2017, supports the use of topical calcineurin inhibitors, including tacrolimus, for the treatment of atopic dermatitis. According to this study, twice-daily application of tacrolimus ointment is efficacious in treating inflamed AD lesions.

Key Considerations

• Tacrolimus 0.03% or 0.1% ointment should be applied thinly to affected areas twice daily until symptoms improve, typically within 1-2 weeks.
• After improvement, reduce to once daily or less frequent application for maintenance.
• Common side effects include temporary burning or stinging sensation upon application, which typically diminishes with continued use.
• Apply to clean, dry skin, and wash hands after application unless treating hand eczema.
• Avoid sun exposure and use sunscreen when using tacrolimus, as it may increase sensitivity to UV light.

Benefits and Risks

• The benefits of using tacrolimus for facial eczema include its effectiveness in reducing inflammation and minimizing the risk of skin thinning associated with topical steroids.
• The risks associated with tacrolimus use include temporary burning or stinging sensation, and potential increased sensitivity to UV light.
• The 2017 study 1 notes that topical calcineurin inhibitors, including tacrolimus, are generally safe and effective for the treatment of atopic dermatitis, but recommends cautious use due to the potential risks.

Alternative Treatments

• If no improvement occurs after 2 weeks of consistent use, consult your healthcare provider for alternative treatments, such as topical corticosteroids or other anti-inflammatory agents.
• The 2014 study 1 suggests that proactive application of topical corticosteroids or topical calcineurin inhibitors can be an effective strategy for preventing disease flares, but notes that the optimal interval of scheduled intermittent use is not clear.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Tacrolimus for Face Eczema

• Tacrolimus is a topical anti-inflammatory treatment that has been shown to be effective in treating atopic dermatitis, including face eczema 2, 3.
• In a study published in 2003, tacrolimus was found to improve the disease by over 90% in 75% of patients with moderate to severe atopic dermatitis after a 1-year treatment period 2.
• Another study published in 2021 found that topical corticosteroids, including those used to treat face eczema, can have adverse effects such as atrophy, striae, and rosacea, especially with prolonged use or application to areas of thinner skin such as the face 4.
• A 2024 Cochrane systematic review and network meta-analysis found that tacrolimus 0.1% was ranked among the most effective treatments for improving patient-reported symptoms and clinician-reported signs of eczema, although it was associated with a higher risk of local application site reactions 3.
• A 2022 study found that potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, but there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids 5.
• A 2014 study compared the efficacy of medium-dose ultraviolet A1 phototherapy and tacrolimus ointment in patients with moderate-severe atopic dermatitis and found that both therapies had a beneficial influence on the course of the disease, although tacrolimus induced a greater reduction in transepidermal water loss 6.

Comparison with Other Treatments

• Tacrolimus has been compared to other treatments such as topical corticosteroids and phototherapy, and has been found to be effective in treating atopic dermatitis, including face eczema 2, 3, 6.
• The choice of treatment for face eczema depends on the severity of the disease, the patient's medical history, and the potential risks and benefits of each treatment option 4, 5.

Safety and Efficacy

• Tacrolimus has been found to be generally safe and effective in treating atopic dermatitis, including face eczema, although it can cause local application site reactions such as burning sensations 2, 3.
• The safety and efficacy of tacrolimus in treating face eczema have been established in several studies, including a 2003 study that found that tacrolimus improved the disease by over 90% in 75% of patients with moderate to severe atopic dermatitis after a 1-year treatment period 2.