From the Guidelines
Protopic should not be used concurrently with light therapy due to safety concerns, as the combination may increase the risk of skin cancer, particularly when considering the photocarcinogenic effects of UVB therapy, as noted in the British Journal of Dermatology study 1. When considering the use of Protopic (tacrolimus) with light therapy, it's essential to prioritize the potential risks associated with this combination. The study by the British Photodermatology Group 1 highlights the importance of cautious use of narrowband ultraviolet B phototherapy, given its potential to induce DNA damage and increase the risk of nonmelanoma skin cancer.
Key Considerations
- The mechanism of tacrolimus as an immunosuppressant may reduce the body's ability to identify and eliminate abnormal cells that might develop due to UV radiation damage.
- The British Journal of Dermatology study 1 suggests that the combined effect of photocarcinogenicity with TL-01 and tacrolimus may theoretically enhance the risk of skin cancer.
- Precautionary measures, such as shielding high-risk areas and minimizing UVB exposure, should be taken to reduce the potential risks associated with this combination.
Recommendations
- Patients should avoid combining Protopic with light therapy whenever possible.
- If both treatments are necessary, a schedule that separates their use should be created, with at least 24 hours between Protopic application and light therapy.
- Alternative treatment options that are more compatible with the specific skin condition should be explored under the guidance of a dermatologist.
- During Protopic treatment, patients should minimize sun exposure and use sun protection measures like sunscreen, protective clothing, and limiting time outdoors during peak UV hours.
From the Research
Safety of Protopic with Light Therapy
- The safety of Protopic (tacrolimus) with light therapy has been evaluated in several studies 2, 3, 4.
- A study comparing topical tacrolimus with medium-dose ultraviolet A1 phototherapy in the treatment of atopic dermatitis found that both therapies were effective in reducing the severity of the disease 2.
- Another study found that the use of topical calcineurin inhibitors, including tacrolimus, was not associated with an increased risk of malignancy 3.
- A consensus-based review of the use of topical tacrolimus in adult atopic dermatitis found that the benefits of the medication outweighed its potential risks when used in the appropriate patient populations for the recommended duration of time 4.
Adverse Effects
- The most common adverse effects of topical tacrolimus are burning and itching, which are usually mild and transient 5, 6.
- A study found that the incidence of adverse events was similar between tacrolimus and pimecrolimus, another topical calcineurin inhibitor 5.
- Serious adverse events were rare and occurred in both the tacrolimus and corticosteroid groups, and were usually considered to be unrelated to the treatment 5.
Interaction with Light Therapy
- There is limited information available on the interaction between Protopic and light therapy.
- However, a study found that UVA1 phototherapy can inhibit the activity of calcineurin phosphatase, similarly to calcineurin inhibitors such as tacrolimus 2.
- Further studies are needed to fully evaluate the safety and efficacy of using Protopic with light therapy.