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Pimecrolimus is a topical immunosuppressive macrolide that may be used in
the treatment of atopic eczema. The mechanism of action of pimecrolimus is not
fully understood however it works mainly by reducing inflammation through suppression
of T lymphocyte responses.
- pimecrolimus is licensed as a first-line
treatment in the UK for atopic eczema - indicated for mild to moderate atopic
eczema in adults and children aged 2 years or older, for short-term treatment
of signs and symptoms and for intermittent long-term treatment to flares (starting
at the first appearance of eczema and continuing until clearance) (1)
is moderately effective in atopic eczema although its place in therapy is unclear
review has stated stated that there was insufficient evidence that pimecrolimus
provided any advantage over less expensive topical corticosteroids ) (1). When
pimecrolimus was compared with a potent topical corticosteroid (betamethasone
valerate 0.1%) in a phase II study, pimecrolimus was found to be less effective
a review states that pimecrolimus is second line treatment for moderate or severe
atopic dermatitis in patients who are not adequately responsive to or are intolerant
of topical corticosteroids (2)
- pimecrolimus ointment 0.03% is not recommended
for use in children aged 2 years or below. pimecrolimus ointment 0.1% should not
be used in children under 16 years of age
- frequency of administration
of pimecrolimus ointment 0.03% in children should be limited to once daily
lower strength of pimecrolimus ointment (0.03%), should be used in adults wherever
- a Drug and Therapeutics Bulletin (3) notes that "the
safety of long-term use of pimecrolimus, in terms of any potential to increase
susceptibility to infection or malignancy, needs to be clearly established"
comparing with tacrolimus in a commentary concerning the management of atopic
eczema, Dr Berth-Jones, consultant dermatologist stated (4):
is more potent than pimecrolimus"
- ..."while tacrolimus seems
likely to be used mainly in the treatment of moderate and severe atopic eczema,
pimecrolimus is likely to prove most useful in mild disease and when used to suppress
further flares of eczema once the condition has been brought under control with
- "like corticosteroids, application of the
new immunomodulators is generally best avoided on infected skin, including areas
affected by warts or molluscum"
- prescribers should use
these products so as to minimise patient exposure and thereby reduce risk. The
following guidance has been recommended (2):
- the medicines should be applied
thinly and to affected skin surfaces only
- treatment should be short term;
continuous longterm use should be avoided
- if no improvement occurs (after
6 weeks for tacrolimus ointment, or 2 weeks for pimecrolimus ointment), or if
the disease worsens, the diagnosis of atopic dermatitis should be reevaluated
and other therapeutic options considered
- MeReC Bulletin (2003);14 (1): 1-4.
- Current Problems in Pharmacovigilance
- Drug and Therapeutics Bulletin (2003); 41:33-40.
(2004); 15 (10): 57-61
Last reviewed 01/2018