Tacrolimus for the Skin?
By A. G. Moore 2/14/2014
Immunofluorescent image of pemphigus
From Wikimedia Commons on share alike license
The first and only time I was prescribed tacrilomus I used it in ointment form. The dermatologist prescribed the medicine as an alternative to a topical steroid.
“This may not work,” she said, as she tore off a sheet from her prescription pad. “But you can try it.”
The ointment proved to be very effective–topical tacrolimus cleared up what had been a minor but persistent issue. The problem not only went away; it never came back.
Since my experience with tacrolimus I’ve learned that this drug is used for many conditions. According to DermNetNZ, topical, oral and IV tacrolimus have been shown to be effective at curbing the symptoms of some serious dermatologic disorders. These include, among others, discoid lupus, psoriasis, atopic dermatitis and pemphigus.
The oral and IV forms of tacrolimus are also sometimes used to suppress tissue rejection after organ transplant surgery. There is some suggestion that this drug may be helpful in controlling symptoms of ulcerative colitis. While its effectiveness in treating UC has only been demonstrated in clinical trials, these trials indicate that tacrolimus may eventually become a valuable treatment option for people who are challenged by this inflammatory bowel disease.
The topical formulation of the drug may be an alternative to steroids for treating dermatologic conditions on the face–especially around the eyes. That’s because these areas have thinner skin than is found elsewhere on the body and steroids have a tendency to thin the skin. Topical tacrolimus is less inclined to do this.
The use of this drug in the treatment of vitiligo appears promising. The Journal of Dermatology reports a study out of Taiwan that indicates topical tacrolimus was effective in reducing symptoms of vitiligo on the face and neck. The Journal of Dermatology article states that about 1/4 of participants in the Taiwan study reported “mild” side effects and all patients “showed repigmentation”.
As for safety during pregnancy, an article posted on MedicineNet suggests caution is advisable. This article also indicates that there may be a relationship between long-term use of tacrolimus ointment and skin cancer. While the MedicineNet article explains that absorption of topical tacrolimus is likely minimal, there are exceptions to this. Among children, to whom a reduced dose is administered (.03%), there is a subgroup that experiences significant systemic absorption of the drug. Children with Netherton Syndrome, an inherited skin disorder, have been shown to have high levels of tacrolimus in their blood streams because of transdermal absorption.
Physicians and parents should take care that Netherton Syndrome not be misdiagnosed as atopic dermatitis. The two disorders may be very similar in appearance.
Any drug that is powerful enough to suppress the immune system after organ transplant is likely to have serious side effects; this is the case with tacrolimus. In looking at side effects from oral and IV administration, the Mayo Clinic provides a rather daunting list of possible adverse events. Another sobering list can be found on WebMD.
Often, if a patient is dealing with an inflammatory dermatologic condition, options can seem limited. Steroids are the go-to remedy, but they have their drawbacks, especially if treatment of the face or neck is necessary. While tacrolimus may offer an alternative treatment, all benefits and side effects (only a few of them mentioned in this piece) must be considered.
The following websites offer additional information about tacrolimus; a qualified medical professional would be able to guide in any decision about whether use of this medicine is appropriate.