Psoriasis treatment: Tacrolimus ointment and pimecrolimus cream

Also called topical calcineurin inhibitors (TCIs) The US Food and Drug Administration (FDA) approved these medications to treat atopic dermatitis (eczema), not psoriasis. It’s perfectly acceptable, however, for doctors to prescribe a medicine to treat another condition. This is called “off-label use.” TCIs can be extremely helpful for some people who have psoriasis. 

Why do dermatologists prescribe a TCI to treat psoriasis?

When applied to the psoriasis, these medications can treat:

• Plaque psoriasis (on the face and other delicate areas like the genitals)

• Inverse psoriasis (armpits, skin under the breasts, groin, or face)

Safety and effectiveness

• These medicines have a good safety record when used as directed.

• Research shows that these medicines can treat plaque psoriasis in delicate areas and inverse psoriasis.

• To increase effectiveness, these medicines may be used along with another medicine such as a corticosteroid that you apply to your skin.

• The long-term safety of these medicines is unknown because TCIs are newer medicines.

• The FDA has placed a warning on these medications, saying that children and adults who use this medicine may have a greater risk of developing lymphoma (cancer of the lymph nodes) or skin cancer. The FDA based its warning on animal studies.

Dermatologists have not seen an increased risk of these cancers in patients who apply tacrolimus (tah-crow-luh-mus) or pimecrolimus (peh-mec-row-lie-mus) to their skin. Dermatologists, however, take extra precautions when they prescribe these medicines. This includes watching their patients very closely.

Dermatologist recommendations

When treating psoriasis with one of these medications, dermatologists recommend: 

• Staying out of the sun

• Wearing pants and long sleeves to protect your skin from the sun’s rays, even if you’re outside for just a few minutes

• Staying out of tanning beds

How to use

Most patients apply these medicines to psoriasis twice a day.

If your dermatologist prescribes one of these medicines, listen carefully to the instructions. Here’s why:

• You may need to apply a TCI to certain areas of your body and another psoriasis medicine to other areas.

• Sometimes, you’ll need to apply a corticosteroid for a few days and then switch to a TCI.

• Some patients need to apply the medication and then cover it. Only cover the psoriasis if your dermatologist tells you to do this.

If you have a skin infection, be sure to treat and clear the infection before using a TCI.

Possible side effects

Skin reactions are the most common possible side effect. These include:

• Burning and itching where you apply the medicine (this tends to disappear as you use the medicine or the psoriasis clears)

• An allergic skin reaction

What to discuss with your dermatologist

You should talk with your dermatologist if you have any of the following: 

• Burning or itching that bothers you

• Other side effects

• Concerns, such as the cancer warning

• Psoriasis worsens

• No improvement after using the medicine for six weeks

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References
Cordoro KM. “Management of childhood psoriasis.” Adv Dermatol. 2008;24:125-69.

Feldman SR. “Treatment of psoriasis.” UpToDate 2015 Jul, Wolters Kluwer Health. Last accessed November 2015.

Lebwohl M, Freeman AK, et al. “Tacrolimus ointment is effective for facial and intertriginous psoriasis.” J Am Acad Dermatol 2004 Nov;51(5):723-30.

Menter A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies.” J Am Acad Dermatol 2009 Apr;60:643-59.