Tacrolimus

What is Tacrolimus?

Tacrolimus can treat severe eczema when conventional treatments, like steroids, haven’t worked. It contains the active ingredient tacrolimus monohydrate, which works to prevent flare-ups and inflammation.^[1] It can treat several types of eczema, including atopic and discoid. While the label mentions that Tacrolimus ointment can be used for atopic eczema, its use for discoid eczema is ‘off-label’ (meaning that it’s not in the patient information leaflet, but it’s still backed by clinical evidence).

Atopic eczema is a chronic (long-term) condition characterised by dry, itchy and inflamed skin.^[2] And Discoid eczema is characterised by round or oval patches of skin filled with fluid, which eventually become dry, crusty and cracked. It’s usually very itchy and prone to getting infected,^[3] so it’s important you treat it quickly to prevent infections.

Both types of eczema are commonly treated with emollients and thick creams, which replenish moisture in your skin. For more severe cases, topical steroids may be used. However, if these don’t work, a topical calcineurin inhibitor (TCI) like Tacrolimus can be used.

How does Tacrolimus work?

Atopic and discoid eczema are multifactorial conditions (meaning they’re caused by more than one factor), with the immune system playing a role in their development. People with eczema usually have an overstimulated immune system. Allergens and irritants cause an immune response, resulting in flare-ups and inflammation.

Tacrolimus monohydrate is a topical calcineurin inhibitor. These drugs suppress your immune system to prevent an immune reaction. It works by binding to molecules like FKBP12, which inhibit the activity of calcineurin.^[4] This prevents the production of inflammatory molecules, therefore reducing swelling and inflammation.

What doses of Tacrolimus are there?

There are two different strengths of Tacrolimus: 0.1% and 0.03%.. It’s used twice a day, once in the morning and once in the evening for as long as your clinician has told you to (this is usually up to six weeks, but can be longer if your symptoms are severe).

How to use Tacrolimus

Tacrolimus can be applied to most areas of the body, including your face and neck. Avoid getting it in your nose, eyes or mouth. If you do, wash and wipe it off. To apply tacrolimus:

1. Apply a thin layer of cream to the affected areas.
2. After using it, wash your hands thoroughly, unless they are also being treated.
3. Use it twice a day, once in the morning and once in the evening.

Your clinician will tell you how long to use it for and at what dosage. Always make sure to follow their advice.

If you want to apply Tacrolimus after a bath or shower, make sure your body is completely dry beforehand. Additionally, don’t bathe or shower after applying the ointment, as this will wash it off.

How long does Tacrolimus take to work?

You should start to see a difference within a week,^[1] and it’s used until your eczema clears up. But if you don’t notice any difference after two weeks, tell your clinician. They may prescribe a higher dose or recommend something else.

What should I do if I make a mistake when taking Tacrolimus?

If you forget to use tacrolimu