Eczema pimecrolimus

Billich A, Aschauer H, Aszodi A, Stuetz A. (2004) Percutaneous absorption of drugs used in atopic eczema Pimecrolimus permeates less through skin than corticosteroids and tacrolimus. Int J Pharm 269 29-35. 

Elidel cream consists of pimecrolimus, which is a calcineurin inhibitor that is used for eczema or psoriasis. Patients should be advised to avoid alcoholic drink during the treatment period as consumption of alcohol may lead to facial flushing and skin irritation. Side-effects associated with the topical administration of pimecrolimus include a burning sensation, pruritus, erythema and skin infections, including folliculitis and, less commonly, impetigo. 

The main adverse effect of pimecrolimus is local skin irritation, with a stinging or burning sensation, which occurs in 30% of patients. Typically, children have less skin irritation than adults. Adverse effects such as local immunosuppression and an increased risk of local bacterial and viral infections (notably eczema herpeticum) are less common than with topical glucocorticoids (5). In addition, there is a lack of skin atrophy (6,7). However, topical corticosteroids have the advantage of better skin penetration than pimecrolimus and will therefore continue to be used for more heavily keratinized skin such as in psoriasis (8). 

Tumorigenicity The rates of tumors among patients with atopic dermatitis or eczema who used topical pimecrolimus have been evaluated in a retrospective cohort study of 953 064 subjects and controls [54 ]. The age- and sex-adjusted hazard ratio for all cancers was 1.15 (95% Cl = 0.99, 1.31). T-cell lymphoma was the only tumor associated with a significantly increased risk (HR = 3.76 95% Cl = 1.71, 8.28). However, after exclusion of patients who had had suspicious lesions before exposure the hazard ratio fell to 2.32 (95% Cl = 0.89, 6.07). 

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