Eczema - Patient's guide

Topical Immunomodulators

Pimecrolimus 1% Cream (Elidel®)
Tacrolimus .1% ointment (Protopic®)

Pimecrolimus 1% Cream (Elidel®)

This is the second topical immunodulator to become available. It is approved for short-term intermittent long term therapy of mild to moderate atopic dermatitis. It is to used in patients older than 2 years who are not immunocompromised where conventional therapy is thought not appropriate or ineffective. This official indication is like that for Tacrolimus except it is for milder eczema.

This drug is well absorbed into the skin but not into the blood stream. A slight burning sensation does occur initially in some users. The cream formulation makes it attractive for use on the face. It is at least as effective as Hydrocortisone. There are no studies against stronger corticosteroids creams. Studies to date show that this drug is safe in infants, children and adults. In Canada and in the US it is approved for children of 2 and over.

Tacrolimus (Protopic®):

This is a new generation of topical immunomodulating agents. It is a calcineurin inhibitor which in turn inhibits the activity of white blood calls called T lymphocytes which produce a cascade of chemicals that increase inflammation The drug has been studied in both children and adults and has been shown to be effective. It is a non-steroid. The most common side effect is of transient burning. It appears to be safe for long term use.

Marked to excellent improvement was seen in moderate to severe eczema in the majority of patients using Tacrolimus 0.1% ointment over a one year period
Arch Dermatol 2000; 136:999-1006

Where and when should it be used?

• This drug is licensed for eczema
• “Who have failed to respond adequately to conventional therapy”
• In practice it is being used often as first treatment

FDA Issues Public Warning Re Elidel® and Protopic®

On February 15, 2005 the US Food and Drug Administration (FDA) Pediatric Advisory Committee recommended a "black box" warning be placed on topical calcineurin inhibitor (Elidel® - pimecrolimus and Protopic® - tacrolimus), followed by the FDA issuing a Public Health Advisory on March 10, 2005 regarding the safety concerns. Click here to read position statements from key organizations.

Cutivate® (Fluticasone propionate)

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• INTRODUCTION
  A synthetic fluorinated corticosteroid recently introduced to Canada but has been available in the U.S market for a number of years. Fluticasone propionate is classified as a medium potency topical corticosteroid...   |   Read more ...



• CLININCAL EXPERIENCE
  Topical corticosteroids are extensively used. Atopic eczema will be used as a model for discussing this new topical corticosteroid. A concern with the use of any long term medication is the potential for...   |   Read more ...



• INDICATIONS
  Used for all inflammatory and pruritic conditions that are corticosteroid responsive e.g. eczema, psoriasis and dermatitis. It should not be used in rosacea, acne, or perioral dermatitis... Read more ...



• PATIENT PROFILE
  4 double blind randomized controlled studies in 772 adults and children showed the once the acute episode of moderate to severe eczema had been treated effectively that twice weekly...   |   Read more ...



• DOSING
  For the acute stage of eczema daily application of Cutivate is recommended. New evidence guides us to apply Cutivate twice a week to maintain control of eczema...   |   Read more ...



• EFFICACY
  Although not indicated for use on children in Canada, studies have shown that once daily application is safe and effective in children with atopic eczema...   |   Read more ...



• COMPLIANCE
  Daily application in the acute phase and thereafter twice weekly maintaince should help with compliance ...   |   Read more ...



• SIDE EFFECTS, SAFETY AND RISKS
  Approx 270 million packs sold since 1990 in US ...   |   Read more ...



• COST OF TREATMENT
  Cost of this drug is in line with other potent topical corticosteroids. Cost effectiveness is seen if effective clinical response is realized. The utilization of a twice a week regimen significantly reduces costs...   |   Read more ...

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View the entire Cutivate® (Fluticasone propionate) presentation.