Topical tacrolimus: A boon to dermatology

Tacrolimus is a member of the newly developed class of immunomodulator agents that have a great potential to change the way that various skin disorders are managed. It acts by inhibiting T cell activation and cytokine release by inhibiting gene transcription. Percutaneous absorption of tacrolimus is higher in diseased skin as opposed to healthy skin, therefore, the drug is taken in at progressively lower quantities as the lesions heal. It is approved for use in the treatment of atopic dermatitis with its safety and efficacy being established in several large scaled randomised controlled trials. Various case series are reports have also found tacrolimus to be effective in patients with a variety of skin disorders, like other kinds of eczema, disorders of cornification, papulosquamous disorders, connective tissue diseases, rosacea, vitiligo and follicular disorders. Tacrolimus appears to be quite safe, with no potential of skin atrophy, and the most common adverse effect being a transient sensation of burning at the site of application. 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.