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Topical Immunomodulator for Eczema Treatment

Tuesday, 26 February 2008

The most recent buzz on steroid-free eczema treatment evolves around the use of topical immunomodulator (TIM). Tacrolimus ointment is the first in the new class of steroid-free Topical Immunomodulators (TIMs), and as such represents the first true breakthrough since the introduction of topical steroids more than 50 years ago for the treatment of T-cell mediated inflammatory skin diseases such as atopic dermatitis.

What is topical immunomodulator?

Some eczema treatments (eczema creams) are considered as topical immunomodulators (TIMs) because they change some of the functions of the immune system that cause atopic dermatitis without suppressing the whole immune system.

These medications do not contain corticosteroids. However, they should only be used during flare-ups.

Topical Immunomodulator Treatments

Topical macrolide immunomodulators (calcineurin inhibitors) are approved for the treatment of atopic dermatitis. These medications do not contain corticosteroids (steroids-free and steroid side effects-free).

TIMs include tacrolimus (Protopic) and pimecrolimus (Elidel).

Tacrolimus (FK 506) is currently available as an ointment with a concentration of 0.03% and 0.1% and pimecrolimus (ASM 981) is available as a 1% cream. Itching, burning and irritation at the application site skin may be observed within the first days of treatment. Patients are asked to minimise/avoid natural or artificial sunlight exposure during topical treatment. Tacrolimus ointments becomes the prioritised medicine for the face lesion.

Topical immunomodulators are not indicated for use in the presence of virus infections such as herpes simplex, herpes zoster, eczema herpeticatum or varicella. So far, they do not cause the associated cutaneous atrophy seen with longterm application of topical corticosteroids. Besides, rebound and tachyphylaxis are reduced compared to those associated with topical corticosteroids.

Why Topical Immunomodulator?

Topical Immunomodulator is mainly used for mild or moderate eczema sufferers, which are representing the majority of people suffering with eczema. Your doctor may prescribe the steroid-free TIMs if both you and your doctor have tried other eczema medications with no or less effective results. Therefore, usually TIMs are prescribed by doctors only after other eczema medication methods fail or less effective.

Some Words of Caution

One has to bear in mind that there are not enough long-term data of these agents to definitely rule out long-term side-effects of topical immunomodulator therapy.

It is recommended to take the following precautions:

  • DO NOT use any TIMs continuously for a long time
  • Use TIMs only on areas of your skin that have eczema
  • DO NOT use TIMs on a child under 2 years old


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