Protopic and Elidel for Psoriasis

Strength Without Steroids

Woman with doctor
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Psoriasis is a common skin condition that changes the life cycle of skin cells, causing cells to build up rapidly on the surface of your skin. The extra skin cells form thick, silvery scales and itchy, dry, red patches that are sometimes painful. Psoriasis is a persistent, long-lasting (chronic) disease. There may be times when your psoriasis symptoms get better alternating with times when your psoriasis worsens.

Treatment for Sensitive Areas

The primary goal of treatment for psoriasis is to stop the skin cells from growing so quickly. While there isn't a cure, psoriasis treatments may offer significant relief. 

But here's a dilemma: You need to treat psoriasis in an area where strong topical steroids may be a problem, but milder corticosteroids are ineffective. What should you do? One easy solution is to use a non-steroid topical medication. However, many of these, such as Dovonex (calcipotriene) or Psoriatec (anthralin) are typically too irritating to use on sensitive facial or groin skin.

For a solution, your doctor may look outside the list of psoriasis drugs that are approved by the Food and Drug Administration (FDA) and utilize some drugs that are used and FDA-approved for eczema. These include Protopic (tacrolimus) and Elidel (pimecrolimus). Using an approved drug for an unapproved use is called "off-label" use and it's not only perfectly legal, it's actually quite common in dermatology practice.

Protopic

Protopic (tacrolimus) is an ointment that can be useful for psoriasis of the face and groin. It's in a class of medications called topical calcineurin inhibitors that help reduce inflammation and plaques. One potential and unusual side effect of Protopic is that if you drink alcohol, the areas in which you applied it can become red and hot.

Common side effects of Protopic include:

  • Burning, stinging, soreness, redness, or tingling in the areas it's applied
  • Feeling hot or cold temperatures more than you used to in the areas it's applied
  • Itching
  • Acne
  • Infected hair follicles
  • Headache
  • Pain in your back or muscles
  • Runny or stuffy nose
  • Flu-like symptoms
  • Nausea

If you experience any of these common side effects and they are severe or don't go away, talk to your doctor.

Serious side effects of Protopic include:

  • Cold sores
  • Blisters or chicken pox
  • Swollen glands
  • Rash
  • Skin infection, which may include oozing, blistering, or crusting
  • Swelling of your hands, arms, legs, ankles, or feet

If you experience any of these serious side effects while using Protopic, seek treatment immediately.

Elidel

Elidel (pimecrolimus) is another topical calcineurin inhibitor that works like Protopic, but its cream base is less greasy and perhaps a bit more comfortable (although it may not be quite as effective for psoriasis). Like Proptic, it can also cause the treated areas to become red or hot when you drink alcohol.

Common side effects of Elidel include:

  • Burning, stinging, soreness, redness, or warmth in the areas it's applied
  • Warts or bumps
  • Eye irritation, if used near your eyes
  • Headache
  • Cough
  • Stuffy or runny nose
  • Nosebleed
  • Diarrhea
  • Pain during your menstrual period

If you experience any of these common side effects and they're severe or don't go away, talk to your doctor. You should also talk to your doctor if you have burning, stinging, soreness, redness, or warmth in the areas you've applied Elidel for more than a week.

Serious side effects of Elidel include:

  • Red or sore throat
  • Fever
  • Hives
  • Ear discharge or pain
  • Flu-like symptoms
  • Itching
  • New or worsening rash
  • Difficulty swallowing or breathing
  • Swelling of your  tongue, throat, face, lips, eyes, hands, ankles, feet, or lower legs
  • Cold sores
  • Blisters or chicken pox
  • Swollen glands in your neck
  • Skin infection, which may include oozing, blistering, or crusting

Call your doctor right away if you experience any of these serious side effects while using Elidel.

Black Box Warning

Several years after their release, both Protopic and Elidel received a "black box" warning because there is a possible link between using them and developing skin cancer or lymphoma. However, subsequent studies haven't found enough evidence to support this potential link. More long-term studies are being conducted, but in the meantime, The American Academy of Dermatology and others have taken the stand that there is no proof that these medications cause cancer and that they are safe and effective when used appropriately.

Off-Label Drugs and Insurance

Whether or not off-label use of these drugs is right for you is a decision you and your dermatologist have to make together. At times, insurance companies are reluctant to cover the use of these relatively expensive drugs when cheaper steroids are available. However, a letter from your dermatologist indicating the specific need for a non-steroid drug in a given circumstance may get the drug approved.

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