The use of topical tacrolimus and pimecrolimus to treat psoriasis: A review The use of topical tacrolimus and pimecrolimus to treat psoriasis: A reviewTacrolimus ointment and pimecrolimus cream are approved in the United States for treatment of atopic dermatitis. Tacrolimus and pimecrolimus are both calcineurin inhibitors and function as immunosuppressants. Their mechanisms have been discussed elsewhere. This article will discuss their utility in treating psoriasis. In the treatment of psoriasis, the topical use of tacrolimus and pimecrolimus has promise [3]. As oral agents both tacrolimus[4] and pimecrolimus[5] are effective in the treatment of moderate to severe plaque psoriasis. However, neither medication has yet to be approved by the FDA for this indication. Some have stated that given orally, pimecrolimus is as potent or superior to tacrolimus in treating ACD in mice and rats [6]. No trial comparing these medications in humans has yet to be performed.Changing the formulation of tacrolimus and pimecrolimus to increase penetration is also a promising means to increase their effectiveness in treating psoriasis. Tacrolimus ointment was compared to liposomal tacrolimus lotion on in the models of Balb/c skin graft survival and ovalbumin-induced delayed-type hypersensitivity reactions in C57BL/6 mice. Radiotracer studies showed that topical application of liposomal tacrolimus achieved nine times the concentration of tacrolimus ointment at a target site [17]. A two-center, randomized, double-blind, vehicle- and positive-controlled patient study was conducted in 23 adult psoriasis patients; twice daily application to test sites without occlusion for 21 days was done with an ointment formulation of pimecrolimus (1 %), the corresponding vehicle, calcipotriol (0.005 %) ointment, and clobetasol-17-propionate (0.05 %) ointment. Erythema, induration, and scaling (score: 0 [absent] to 4 [severe]) were evaluated.
