Topical calcineurin inhibitors

Topical calcineurin inhibitors are immunomodulatory treatments, which help modulate the immune system to reduce inflammation. Cal cineurin is a protein phosphatase 2B responsible for activating the transcription of interleukin 2 (IL-2), which stimulates the growth and differentiation of T-cell response inhibitors (Hultsch et al., 2005); these are non-steroid drugs. Tacrolimus (Protopic^®) and pimecrolimus (Elidel^®) are the available topical immunosuppressant agents which may be used as alternative to (topical) steroids topical for eczema. Tacrolimus (Protopic^®) for moderate to severe atopic eczema in patients 2 years of age and above, which is not adequately responding to conventional therapies such as topical corticosteroids (Electronic Medicines Compendium [EMC], 2009a). Pimecrolimus (Elidel^®) is indicated for treatment of patients aged 2 years and over, with mild or moderate atopic dermatitis where treatment with topical corticosteroids is either inadvisable or not possible (EMC, 2009). NICE recommends that topical calcineurin inhibitors should not be used to treat mild atopic eczema or as ‘first-line’ treatments (NICE, 2004b). Tacrolimus has also now been licensed in the UK for intermittent use.