The drug atlas
Dermatology/Topical calcineurin inhibitor
Topical calcineurin inhibitors
also: tacrolimus ointment · pimecrolimus · Protopic
Overview
Steroid-sparing topical immunomodulators — no skin atrophy, so ideal for the face, eyelids and flexures.
Mechanism
Inhibit calcineurin → block dephosphorylation of NFAT → ↓T-cell IL-2 transcription → reduced T-cell activation and cutaneous inflammation. No effect on collagen → no atrophy (unlike steroids).
Indications
- Atopic eczema (esp. face/flexures, steroid-sparing)
- Maintenance/proactive therapy at flare-prone sites
The agents
Tacrolimus ointmentmore potent
0.03%/0.1%
Moderate–severe eczema.
Pimecrolimus creammilder
1%
Mild–moderate, face.
Adverse effects
Burning / stinging on applicationclassic
Transient; warn the patient.
Photosensitivitycommon
Advise sun protection.
Theoretical malignancy risk (boxed warning, not confirmed)common
Cautions & contraindications
Active skin infection (esp. herpes / eczema herpeticum)all
Avoid excess UV / phototherapy concurrentlyall
Interactions
- Alcohol → facial flushing
Monitoring & kinetics
Clinical response; sun protection counselling
Topical BD; safe for long-term proactive use at flexures/face.
Source: NICE NG57 — Atopic eczema · BNF — Tacrolimus (topical)