Medical Editor: Leslie J. Schoenfield, MD, PhD
The word "breakthrough" is overused. If every hot item reporters gush about on the evening health news were the real thing, we would have "broken through" a long time ago. Instead, the word is often applied to soon-forgotten advances that aren't and cures that don't.
Every once in a while, however, something new comes along that represents a genuine breakthrough. In 2001, the FDA approved tacrolimus (brand-name: Protopic) for treating eczema, also known as atopic dermatitis. Protopic is the first effective nonsteroid treatment for this common, chronic, itchy condition. A related drug, pimecrolimus (brand-name: Elidel), is now on the market.
These new drugs are referred to as "immune modulators." They were first used internally to help patients with kidney and liver transplants avoid rejecting the organs they received. They work by suppressing the immune system. When these drugs are used externally to treat the skin, however, they do not weaken or change the body's immune system. Also, unlike topical steroids (cortisone creams), these new medications don't cause thinning of the skin and breaking of superficial blood vessels (atrophy).
The major side effect of these new topical medications is a sensation of burning of the skin. Some patients complain that their skin stings or burns for a period after they apply the cream. This feeling tends to lessen as the skin heals. At this point neither Protopic nor Elidil is approved for use in children under the age of 2. However, when further studies are complete, doctors will most likely be able to treat infants and very young children too.
The good news is that these immune modulators work. Many patients who respond poorly or not at all to topical steroids do very well when they use this new class of medication. This doesn't mean that steroid creams won't be used anymore. Properly prescribed, these old standbys are safe and effective for many situations, even for children, or in sensitive areas like the face or groin.
It is also important to remember that no drugs, including the new ones, cure eczema altogether. This condition represents an inherited sensitivity that tends to recur throughout life. Still, many patients with atopic dermatitis will now be able to achieve comfortable and better-looking skin by using tacrolimus, pimecrolimus, and the related medications that are sure to follow.