Pimecrolimus

How it works

It is a calcineurin inhibitor that blocks T-lymphocyte activation and the production of inflammatory cytokines, reducing the inflammation of atopic eczema without causing skin atrophy.

Prescribing in practice

• Advise effective sun protection and avoidance of UV light, and counsel that it is applied to affected areas only as a corticosteroid-sparing option, not for continuous indefinite use.
• A transient burning, warmth or stinging sensation on application is common in the first days of treatment.
• It should not be applied to skin that is actively infected, and viral skin infections should be cleared before use.

Monitoring

Review eczema control and treated skin for infection, and reassess if there is no improvement after an adequate trial.

Counselling the patient

• A short-lived burning or warm feeling when you first apply it is normal and usually settles.
• Protect treated skin from strong sunlight and use sunscreen.
• Do not apply it to broken or infected skin, such as cold sores.

Evidence & guidelines

Topical calcineurin inhibitors are recommended in NICE guidance as second-line options for atopic eczema not adequately controlled by, or where there are concerns about, topical corticosteroids.