From the Guidelines
It is not recommended to have phototherapy while using Protopic (tacrolimus) due to the potential increased risk of skin cancer and lymphoma. Protopic is a topical calcineurin inhibitor that works by suppressing the immune system in the skin to reduce inflammation in conditions like eczema. When using Protopic, you should avoid both natural sunlight and artificial UV light sources including phototherapy, as stated in the study by 1. This is because tacrolimus may increase your risk of developing skin cancer and lymphoma, and this risk could potentially be heightened by UV exposure.
The study by 1 highlights the concerns regarding the increasing use of topical immunomodulators such as tacrolimus, as the combined effect of photocarcinogenicity with TL-01 may theoretically enhance the risk of skin cancer. Although the study by 1 focuses on psoralen-ultraviolet A therapy, it also emphasizes the importance of considering risk factors associated with skin cancer, including immunosuppressive drug therapy.
Some key points to consider when using Protopic and phototherapy include:
- Avoiding concurrent use of phototherapy with Protopic due to the potential increased risk of skin cancer
- Alternating therapies, such as using Protopic during breaks from phototherapy, or using Protopic on certain body areas while treating others with light therapy
- Stopping Protopic for at least 24 hours before phototherapy sessions, as recommended by your doctor
- Following your healthcare provider's specific instructions regarding the timing and use of these treatments to ensure safety and effectiveness.
It is essential to prioritize caution when combining Protopic with phototherapy, and to carefully weigh the potential benefits and risks of these treatments, as suggested by the study by 1.
From the Research
Phototherapy and Protopic Use
- The use of phototherapy in combination with topical calcineurin inhibitors, such as Protopic (tacrolimus), has been studied in various contexts, including the treatment of vitiligo and atopic dermatitis 2, 3.
- A study published in 2021 found that the long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo 2.
- Another study from 2014 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 3.
Safety Considerations
- Phototherapy can have adverse effects, including skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis 4.
- However, most studies have not found an increased risk of non-melanoma or melanoma skin cancer in patients treated with ultraviolet B (broadband and narrowband) and ultraviolet A1 phototherapy 4, 2.
- Patients submitted to phototherapeutic regimens should undergo complete, careful dermatologic examination regularly and lifelong 4.
Treatment Protocols
- Narrowband UVB phototherapy is considered a safe and effective treatment modality for psoriasis, and is often used in combination with topical treatments such as Protopic 5, 6.
- The treatment protocol for phototherapy can vary depending on the specific condition being treated, and should be developed independently to suit each patient's needs 5.