Eczema treatment: Topical calcineurin inhibitors (TCIs) for children
When is this medicine prescribed?
Your child’s dermatologist may prescribe this medicine when corticosteroids stop working, fail to work, or are not a good option for your child.
Pronounce: cal-see-neur-in
Why do dermatologists prescribe TCIs for eczema?
When applied to eczema, this medicine can reduce the:
Inflammation (redness, swelling, heat)
Itch
Excessive S. aureus bacteria on the skin
Your child’s dermatologist may prescribe this medicine when a topical corticosteroids stop working, fail to work, or are not a good option for your child.
Your child’s dermatologist may also prescribe a TCI along with a topical corticosteroid. For example, if your child will need medicine applied around the eyes, a TCI may be prescribed to treat only the skin around the eyes.
FDA approval
The U.S. Food and Drug Administration (FDA) has approved 2 TCIs to treat eczema:
1. Pimecrolimus (peh-mec-row-lie-mus) cream:
Brand name: Elidel®
Approved to treat mild to moderate eczema in patients 2 years of age and older.
2. Tacrolimus (tah-crow-luh-mus) ointment:
Brand name: Protopic®
Approved to treat moderate to severe eczema
.03% approved to treat patients 2 years of age and older.
.01% approved to treat patients 15 years of age and older.
Both are FDA approved for:
Non-continuous use for up to 12 months
Treating patients who have an immune system that can fight infections
Safety and effectiveness
TCIs are “steroid sparing.” This means that using a TCI avoids side effects possible with topical corticosteroids, such as thinning skin.
TCIs have a good safety record when used as directed.
The most common side effects are burning and stinging, which are normal and tend to disappear as the skin heals.
Some (not all) topical corticosteroids can be safely used along with a TCI. Dermatologists have the expertise to know which ones can be combined safely — and which ones cannot.
Always consult your child’s dermatologist before using both a TCI and a corticosteroid — even a topical corticosteroid like hydrocortisone, which you can buy without a prescription.
Because TCIs are newer medicines, the long-term safety of these medicines is unknown.
In studies, tacrolimus has been found to be as effective as a mid-potency topical corticosteroid. It is believed (no studies conducted) that pimecrolimus is as effective as a low-potency topical corticosteroid.
Best results are obtained when used along with bathing, an eczema friendly moisturizer, and trigger management.
Why do TCIs include a cancer warning?
In clinical trials, TCIs were found to help many patients with eczema. A few patients with eczema who have used a TCI, however, have developed skin cancer or lymphoma (cancer that begins in a lymph gland).
Scientists do not have enough evidence to know whether these people would have developed one of these cancers if they had not used a TCI. Due to this situation, the general conclusion right now is: “At this time, the risk of developing cancer remains unknown.”
Scientists say the risk is unknown because several studies have noted that people with severe eczema may have a greater risk of developing lymphoma. This occurs in people who have never used a TCI.
As such, when dermatologists prescribe a TCI, they take the following precautions. They:
Watch each patient closely.
Prescribe for the shortest time considered safe, often just long enough to calm the skin so that it can heal.
Tell patients to stay out of the sun and avoid tanning beds while a TCI is part of the treatment plan. This reduces the possible increased risk of skin cancer.
Do not prescribe phototherapy while a patient is using a TCI.
How to use
If your child has a skin infection, treat the infection and make sure it is gone before applying a TCI.
Follow the dermatologist’s instructions carefully. You may need to apply a TCI to certain areas of your child’s body and a topical corticosteroid to other areas. Another possibility is that you may need to apply a topical corticosteroid for a few days and then switch to a TCI.
Apply TCIs only to the eczema
Possible side effects
Stay out of the sun
All children should stay out of the sun while a TCI is part of their eczema treatment plan.
The most common side effects reported in children are:
Burning or stinging when TCI applied to the skin: As the skin heals, this tends to disappear.
Itchy skin where TCI applied
Fever
When should I call my child’s dermatologist?
Call your child’s dermatologist, if you apply a TCI to your child’s skin and notice any of the following:
Eczema worsens
Skin infection develops
No improvement after applying for 6 weeks (8.8, 606)
Related AAD resources
Images
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References Berger TG, Duvic M, et al. “The use of topical calcineurin inhibitors in dermatology: Safety concerns.” J Am Acad Dermatol. 2006;54:502-8.
Eichenfield LF, Tom WK, et al. “Part 2: Guidelines of care for the management and treatment of atopic dermatitis with topical therapies.” J Am Acad Dermatol. 2014 Jul;71(1):116-32.