Protopic
Meaning of Protopic: The ointment form of tacrolimus, valued in eczema mainly because it spares the skin from the thinning that steroids cause.
Definition of Protopic
Protopic is a brand name for tacrolimus ointment, a treatment applied to the skin for eczema. It calms the overactive immune reaction in the skin without using a steroid, so it does not thin the skin the way long term steroid creams can. It is generally reserved for eczema that has not settled with other treatments.
How does it work?
In eczema, immune cells within the skin overreact and keep the inflammation running. Tacrolimus blocks calcineurin, a protein that T cells need in order to switch on and release inflammatory signals. Without that step the cells stay quiet and the skin settles. Steroid creams reduce inflammation by a different route, acting on gene activity in many cell types at once, which is why the two have different side effects while treating the same problem. The tacrolimus molecule is large, so very little passes through skin into the bloodstream.
Why use it instead of a steroid cream?
| Tacrolimus ointment | Topical steroid | |
|---|---|---|
| Thins the skin | No | Yes, with prolonged use |
| Used on face and eyelids | Yes, a common reason it is chosen | Only weak preparations, and briefly |
| Burning or stinging when applied | Common at first, usually fading | Uncommon |
| Effect on immunity elsewhere in the body | Minimal from skin use | Minimal from skin use |
Skin thinning is the reason steroid creams are limited on delicate areas, and avoiding it is the main advantage of this alternative.
What is known about its safety?
Stinging, burning or a feeling of warmth at the treated site is the usual complaint and tends to ease over the first days of use. Alcohol can bring on facial flushing during treatment. The product carries a boxed warning about a possible link with lymphoma and skin cancer, added on theoretical grounds because tacrolimus taken by mouth after a transplant suppresses immunity throughout the body and raises those risks. Long term study of the skin preparation has not confirmed the same link, but the warning remains and the labeling recommends limiting sun exposure during treatment.
How does it fit with other treatments?
Tacrolimus ointment is one of two calcineurin inhibitors applied to skin, the other being pimecrolimus cream, which is generally milder. Neither is a first choice for mild eczema, where moisturizers and short courses of steroid do the work. They come into use where eczema keeps returning in the same delicate places, where steroids have already thinned the skin, or where a steroid free option is wanted to hold the condition steady. The same drug given as capsules or by injection is an entirely different proposition, since it then suppresses immunity across the whole body.
Also known as
Used in a sentence
Tacrolimus ointment sold as Protopic was applied to areas of facial eczema where steroid creams had thinned the skin.
Good to know
The boxed warning on tacrolimus ointment was applied by extension from the effects of the drug taken by mouth after transplantation, and long term study of the skin preparation has not confirmed the same risk.