What non-steroidal prescription medicine is recommended for dermatitis?

From the Guidelines

For non-steroidal treatment of dermatitis, topical calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) are recommended prescription medications. These are typically applied twice daily to affected areas until symptoms improve. Tacrolimus comes in 0.03% and 0.1% strengths, while pimecrolimus is available as a 1% cream. These medications work by suppressing the immune response in the skin without the side effects of steroids, such as skin thinning or rebound effects. They're particularly useful for sensitive areas like the face, eyelids, and skin folds, or for patients who haven't responded well to topical steroids. Some patients may experience temporary burning or stinging upon application, which typically subsides with continued use. These medications are safe for longer-term use than topical steroids and don't cause the same adverse effects with prolonged application. For best results, apply to clean, dry skin and wash hands after application unless treating hand dermatitis. According to the most recent guidelines 1, the use of phototherapy or systemic therapies may be considered for patients with more severe or widespread dermatitis, but topical calcineurin inhibitors are generally recommended as a first-line treatment. The guidelines also recommend against the use of systemic corticosteroids for long-term treatment of dermatitis due to their potential side effects 2.

Some key points to consider when using topical calcineurin inhibitors include:

• They are safe for use on sensitive areas of the skin
• They can be used for long-term treatment without the same risks as topical steroids
• They may cause temporary burning or stinging, but this typically subsides with continued use
• They should be applied to clean, dry skin and hands should be washed after application unless treating hand dermatitis.

It's also important to note that the decision to initiate treatment with topical calcineurin inhibitors should be made using shared decision-making between patients and clinicians, taking into account the severity of the dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 3.

In terms of systemic treatments, the guidelines recommend the use of certain medications such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib for patients with severe or refractory dermatitis 1. However, these medications are typically reserved for patients who have not responded to topical treatments or who have more severe disease.

Overall, topical calcineurin inhibitors such as tacrolimus and pimecrolimus are a safe and effective treatment option for non-steroidal treatment of dermatitis. They can be used for long-term treatment and are particularly useful for sensitive areas of the skin or for patients who haven't responded well to topical steroids.

From the FDA Drug Label

ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. The recommended non-steroidal prescription medicine for dermatitis is pimecrolimus (TOP), specifically ELIDEL Cream 1% 4.

• It is used for the treatment of mild to moderate atopic dermatitis.
• It is indicated for non-immunocompromised adults and children 2 years of age and older.
• It should be used as second-line therapy for patients who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable.

From the Research

Non-Steroidal Prescription Medicines for Dermatitis

• Tacrolimus and pimecrolimus are two topical noncorticosteroid immunomodulators that have been shown to be effective in treating atopic dermatitis 5, 6, 7, 8.
• These medicines work by binding to the FK-binding protein (FKBP) and inhibiting the activation of T cells, which helps to reduce inflammation and improve skin barrier function 5.
• Tacrolimus has been shown to be more effective than pimecrolimus in some studies, with a higher efficacy and better tolerance 7.
• Both tacrolimus and pimecrolimus have been associated with some adverse events, such as burning sensation and increased pruritus at the site of application, but these are typically mild and short-term 5, 6, 8.
• Long-term safety studies have not revealed any significant adverse effects, and there is no strong evidence of an increased risk of malignancy with the use of these medicines 6, 8.

Recommended Treatment

• Tacrolimus and pimecrolimus can be used as a first-line treatment for atopic dermatitis, especially for patients who are concerned about the potential side effects of topical corticosteroids 5, 9.
• The choice between tacrolimus and pimecrolimus may depend on the individual patient's needs and preferences, as well as the severity of their condition 7.
• Maintenance therapy with intermittent application of tacrolimus or pimecrolimus can help to reduce the frequency and severity of relapses 6.