Tacrolimus (Topical)

How it works

Tacrolimus inhibits calcineurin within T-lymphocytes, blocking the dephosphorylation of NFAT and thereby suppressing transcription of pro-inflammatory cytokines and the cutaneous inflammatory response, without the skin-atrophy effects of corticosteroids.

Prescribing in practice

• A transient burning or stinging sensation at the application site is common in the first days of treatment, and patients should avoid excessive natural or artificial UV exposure (including sunbeds) given a theoretical malignancy concern flagged by the MHRA.
• It is reserved for eczema unresponsive to, or where there is a risk of harm from, conventional topical corticosteroids, and should not be applied to infected or potentially malignant skin lesions.
• Initiation is generally by, or under the guidance of, a prescriber experienced in atopic eczema, with the lower-strength preparation used in children.

Monitoring

No routine blood monitoring is needed; review treatment response and the application site, reassessing if lesions fail to improve or appear infected.

Counselling the patient

• Apply a thin layer to affected skin only and wash hands afterwards unless treating the hands.
• Mild burning or itching when starting usually settles within a few days; alcohol may worsen facial flushing.
• Protect treated skin from strong sunlight and avoid sunbeds while using it.

Evidence & guidelines

Topical tacrolimus is recommended by NICE as a second-line option for atopic eczema not controlled by topical corticosteroids, particularly for the face and neck.