Tacrolimus is one of the newer
immunosuppressants that act by inhibiting T-cell activation and
cytokine release. It is approved for the treatment of
atopic dermatitis, and its safety and efficacy have been extensively studied in large-scale randomized controlled trials and open-label studies worldwide involving over 12,000 patients and up to 3 years of follow-up. Since its introduction, anecdotal reports and case series have found topical
tacrolimus also to be effective and well tolerated in patients with a variety of other skin disorders, including other types of
eczema,
papulosquamous disorders, disorders of cornification,
rosacea, other inflammatory skin conditions, vesiculobullous diseases,
vitiligo,
connective-tissue diseases,
graft-versus-host disease, and follicular disorders. This paper reviews the currently available evidence on the use of topical
tacrolimus for these conditions, as well as its safety profile and cost-effectiveness.
Tacrolimus does appear to offer a safe and efficacious alternative that minimizes the need for topical
glucocorticoids and does not cause skin
atrophy. However, the risk of systemic absorption is increased with generalized disruption of the skin barrier. Further large-scale studies are needed to clarify the efficacy of topical
tacrolimus in a variety of conditions for which anecdotal reports of success exist, especially in regard to different racial groups and in comparison to (as well as in combination with) other existing
therapies. Long-term safety data should continue to be monitored and reported.