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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.

father and son playing

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.

4 smiling children leaning on the back of a couch

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: Getty Images

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.

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