Pimecrolimus

INTRODUCTION

Indications

Short-term and intermittent long-term management of mild-to-moderate atopic dermatitis unresponsive to or in patients intolerant of conventional treatment.

Action

Inhibits T-cell and mast cell activation by interfering with production of inflammatory cytokines. Therapeutic Effects: ↓ severity of atopic dermatitis.

Adverse Reactions/Side Effects

Local: burning. Misc: ↑ risk of lymphoma/skin cancer.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess the area being treated to help document whether drug therapy is successful in resolving skin conditions.

• Monitor any new or increased skin reactions at the site of application, including burning, rash, or other suspicious skin lesions that might indicate skin cancer or lymphoma. Report severe or unusual skin reactions to the physician.

Patient/Client-Related Instruction

• Check that the patient and family or caregivers understand topical application procedures and adhere to the recommended dosing schedule.

Pharmacokinetics

Absorption: Minimally absorbed through intact skin.

Distribution: Local distribution after topical administration.

Metabolism and Excretion: Systemic metabolism and excretion is negligible with local application.

Half-life: Not applicable.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Should not be applied to areas of active cutaneous viral infections (increased risk of dissemination); Concurrent use of occlusive dressings; Netherton's syndrome (increased absorption of pimecrolimus); Lactation: Discontinue breast-feeding.

Use Cautiously in: Possible risk of cancer. Do not use as first-line therapy; Clinical infection at treatment site (infection should be treated/cleared prior to use); Skin papillomas (warts); allow treatment/resolution prior to use; Natural/artificial sunlight (minimize exposure); OB: Use only if clearly needed; Pedi: Use only if other treatments have failed; safety not established in children <2 yr.

Interactions

Drug-Drug: None significant as systemic absorption is negligible.

Route/Dosage

Topical (Adults and Children ≥2 yr): Apply thin film twice daily; rub in gently and completely.

Availability

Cream: 1% in 30-g, 60-g, and 100-g tubes.