Pilocarpine is a naturally occurring cholinomimetic agent possessing both muscarinic and nicotinic properties

FIGURE 78 Pilocarpine is a naturally occurring cholinomimetic agent possessing both muscarinic and nicotinic properties. It causes miosis, reduces intraocular pressure, and is used in the treatment of wide-angle glaucoma. In addition, it may be applied topically in the eye in the form of a dmg reservoir. 

Pimecrolimus is a topical immunomodulater. It inhibits T-cell activation by blocking the transcription of early cytokines. It is indicated in short-term and intermittent longterm treatment of mild to moderate atopic dermatitis in nonimmunocompromised patients. 

Pimecrolimus 1% cream (Elidel), a macroMe derived from ascomycin, is FDA approved for the treatment of atopic dermatitis in patients older than 2 years of age. 

Its mechanism of action and side-effect profile are similar to those of tacrolimus. Burning, although occurring in some patients, appears to be less common with pimecrolimus than with tacrolimus. In addition, pimecrolimus has less systemic absorption. Similar precautions with regard to UV exposure should be taken during treatment with pimecrolimus. 

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