Pimecrolimus perioral dermatitis


2005 Jul;36(1):87-8. Such conditions include but are not limited to:

  • Mild to severe atopic dermatitis in patients under 2 years of age[1][2]

  • Eczematous dermatitis of the eyelids,[3] intertriginous (skin fold) areas, or hands[4]

  • Facial and inverse psoriasis[5]

  • Oral and genital lichen planus[6][7]

  • Lichen sclerosis[8]

  • Seborrheic dermatitis[9]

  • Perioral dermatitis[10]

  • Vitiligo[11]

  • Pyoderma gangrenosum[12]

  • Rosacea[13]

  • Cutaneous dermatomyositis[14]

  • Cutaneous lupus erythematosus[15]

  • Cutaneous chronic graft-versus-host disease (GVHD)[16]

Mechanism of Action

Activation of T-lymphocytes starts with the interaction of costimulatory ligands on antigen-presenting cells and T-cell receptors.

J Cosmet Dermatol. Generally, these side effects will improve with repetitive use or mitigated by using topical steroids before the initiation of pimecrolimus.

Several other side effects have been reported with the use of topical pimecrolimus, although they are relatively uncommon or have not been proven to be a direct result of treatment.

[PubMed: 17083882]

19.

Tennis P, Gelfand JM, Rothman KJ. Evaluation of cancer risk related to atopic dermatitis and use of topical calcineurin inhibitors. N Engl J Med. 1982 Nov 25;307(22):1384-8. [PubMed: 15895116]

17.

Hanna S, Zip C, Shear NH. What Is the Risk of Harm Associated With Topical Calcineurin Inhibitors?

[PubMed: 18005117]

16.

Schmook T, Kraft J, Benninghoff B, Nindl I, Roewert J, Ulrich C, Stockfleth E. Treatment of cutaneous chronic graft-versus-host disease with topical pimecrolimus. BMC Pediatrics. Clinicians (MDs, DOs, NPs, PAs), including specialists, will initiate treatment but should use pharmacist resources to verify dosing and indications, as well as potential drug-drug interactions.

It is considered a second-line treatment for immunocompetent patients who have failed first-line options such as topical corticosteroids and emollients.

Off-label Use

Off-label use of pimecrolimus cream applies to several inflammatory or otherwise “steroid-responsive” dermatoses, especially for sensitive or thin skin where there may be a higher risk of local side effects related to topical steroids.

[PMC free article: PMC3162265] [PubMed: 21909206]

15.

Wollina U, Hansel G. The use of topical calcineurin inhibitors in lupus erythematosus: an overview. Br J Dermatol. [Level 5]

In 2014, a workgroup consisting of experts in atopic dermatitis put forth an update on evidence-based treatment guidelines. Br J Dermatol. Br J Dermatol.

[PubMed: 28589618]

10.

Schwarz T, Kreiselmaier I, Bieber T, Thaci D, Simon JC, Meurer M, Werfel T, Zuberbier T, Luger TA, Wollenberg A, Bräutigam M. A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis. [PubMed: 21353334]

9.

Zhao J, Sun W, Zhang C, Wu J, Le Y, Huang C, Liu Y, Xiang L.

Comparison of different regimens of pimecrolimus 1% cream in the treatment of facial seborrheic dermatitis. Atopic patients, in particular, are at a higher risk than the general population of certain bacterial and viral skin infections such as Staphylococcus aureus colonization leading to impetigo or more widespread distribution of herpetic lesions called eczema herpeticum.