Topical tacrolimus for eczema : beyond atopic dermatitis

The safety and efficacy of topical tacrolimus for treatment of atopic dermatitis has been well demonstrated in numerous large-scale randomized controlled trials and open-label studies. On the basis of anecdotal reports and case series, tacrolimus also appears to be efficacious in a variety of other skin conditions. The efficacy of topical tacrolimus has been demonstrated for contact dermatitis, hand eczema, seborrheic dermatitis, flexural psoriasis, oral lichen planus, facial lupus erythematosus, autoimmune bullous dermatosis, and vitiligo. As further studies are conducted, it is likely that new applications for topical tacrolimus will be found. Topical tacrolimus prevent the transcriptionof inflammatory cytokines dependent on the transcription factor NF-AT (nuclear factor of activated Tcells). This reversible inhibition of cytokine synthesis affects both T helper type 1 (TH 1) cytokines (IL-2, interferon-gamma) and TH 2 cytokines (IL-4, IL-10). The main cellular targets for topical tacrolimus are T lymphocytes and mast cell. Unlike topical corticosteroids, Topical tacrolimus has no effect on keratinocytes and fibroblasts and do not induce skin atrophy. Prolonged use of potent or moderately potent topical corticosteroids (TCS) disrupts the structure of the skin barrier, thins the stratum corneum (SC) and as a result reduces permeability barrier function. The effect of topical calcineurin inhibitors (TCI) on the skin barrier is still unclear. But, several publications suggest that topical tacrolimus improved SC integrity, exerted an overall hydrating action, and significantly reduced trypsin-like protease activity, so that improved the condition of the skin barrier. According to current data, topical tacrolimus is a safe and efficacious alternative that minimizes the lifetime need for topical glucocorticoid application. However, further studies with long-term follow-up are required to clarify its efficacy.