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Protopic & Elidel
They both come with an FDA Black Box Warning which concerns some people, but the FDA believes the benefits outweigh the danger.
Protopic (tacrolimus) ointment (0.03%, 0.1%) and Elidel (Pimecrolimus) cream (1%) are currently FDA-approved in the United States for atopic dermatitis in adults and children aged 2 years and older. These are topical calcineurin inhibitors. In addition to their anti-inflammatory effects, these agents have demonstrated in vitro antifungal activity against M. furfur and pityrosporum spp fungi. The
following offers a closer look at the performance of these agents: see Skin & Aging for the role of Malassezia fungus in seborrheic dermatitis and why it may be treated with Protopic and Elidel.
See, also, this article on "How a Fungus Can Beat Eczema"
Comparison of Protopic (Tacrolimus) with Elidel (Pimecrolimus) from SkinTherapyLetter.com
Topical tacrolimus and pimecrolimus have not been directly compared in a published, controlled clinical trial. Nevertheless, we may draw inferences from the medical literature. A double-blind, randomized, parallel-group, multicenter study compared pimecrolimus cream with betamethasone valerate, a mid-potency topical corticosteroid agent. In this trial, betamethasone valerate was more effective than pimecrolimus cream 1%.22 Because topical tacrolimus is at least as effective as a mid-to-high potency corticosteroid agent, and tacrolimus demonstrates a 3-fold greater binding affinity to the FKBP compared with pimecrolimus, pimecrolimus can be expected to be substantially less effective.23 This is further corroborated by the finding that tacrolimus ointment (0.1% and 0.03%) is approved for moderate-to-severe AD, whereas pimecrolimus cream in over 30 times the drug concentration (1%) is approved for mild-to-moderate AD.
In a recent multicenter, randomized, investigator-blinded, comparative study performed by one of the authors (ABF) and presented at the 2003 European Academy of Dermatology and Venereology Meeting, tacrolimus ointment 0.1% was substantially more effective than pimecrolimus 1% cream. This study of children, aged 2–16 with moderate-to-severe atopic dermatitis followed subjects prospectively for 6 weeks. Of 193 evaluable total subjects, nearly twice as many achieved clearance or near clearance with tacrolimus than with pimecrolimus (38% vs. 20%, p=0.006). There were no differences in side-effect profile including burning, stinging, and itching. These data confirm the expected efficacy differences and confirm the relative safety of both as being indistinguishable.
Although supporting the use of topical tacrolimus by dermatology specialists, the National Prescribing Centre in Britain recently recommended against the general use of pimecrolimus, given its limited efficacy.4 Despite these recommendations, the authors of this review, as dermatologists, do prescribe pimecrolimus. Pimecrolimus is especially useful for adult patients to use in the morning on the face, to avoid the shininess of an ointment. When given a choice between a more effective ointment and a less effective cream, most but not all patients will choose the ointment.
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