Why does protopic burn

Background: Tacrolimus is an immunosuppressant drug currently used for the treatment of atopic dermatitis and pruritus. This topical therapy is effective and safe, but transient burning, stinging and itch are frequently reported. Objectives: To understand the mechanisms underlying these burning sensations. In general, the burning sensation, pruritus and erythema resolve within one week of initiating topical tacrolimus and occur more frequently in adults than in children.

These complications are related to disease severity. Such events decrease rapidly as AD lesions heal with improving skin barrier and skin hydration 3, 8, 9. The mechanism of the burning sensation following topical tacrolimus is not fully understood. Tacrolimus is known to activate dorsal root neurones in rodents and to induce neuropeptide release and mast cell degranulation in murine skin The key molecule of cutaneous nerve activation is the non-selective cation channel, transient receptor potential vanilloid 1 TRPV1.

The application of tacrolimus could stimulate sensory neurones and increase the phosphorylation of TRPV1 channels, which leads to the release of inflammatory neuropeptides, including substance P and calcitonin gene-related peptide. As a consequence, this may promote cutaneous neurogenic inflammation locally around nerve endings, transient burning or painful sensations 11, With a disrupted skin barrier function, more tacrolimus molecules can be absorbed, and side-effects, such as burning or pruritus of the AD lesions, would occur.

Steroid-free over-the-counter moisturizers may counteract TEWL caused by a defective skin barrier. Controlled clinical trials have demonstrated that moisturizers improve the symptoms of AD, particularly pruritus, erythema, fissuring and lichenification In the current study, most of the discontinued patients could tolerate topical tacrolimus mixed with moisturizer.

Previously, Al-Khenaizan 14 suggested that pre-cooling of topical tacrolimus ointment reduced the burning sensation. This is another good method to mitigate the burning sensation, but cooling the tube for a prolonged time might cause the medication to become inspissated and difficult to extract.

In conclusion, increased TEWL can be a predictor of topical tacrolimus-associated burning sensation. Use of a moisturizer and a gradual increase in dose of topical tacrolimus are recommended for the prevention of the burning sensation. Toggle navigation. Content » Vol 97, Issue 8. Short communication. Click to show fullsize. Table I. Skin barrier dysfunction measured by transepidermal water loss at 2 days and 2 months predates and predicts atopic dermatitis at 1 year.

J Allergy Clin Immunol ; — e1. Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis. J Dermatol Sci ; 76— The safety of tacrolimus ointment for the treatment of atopic dermatitis: a review. My hands started itching right after they started peeling. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.

Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. Do not apply the ointment to any areas of skin which could be infected.

In this article About tacrolimus ointment Before using tacrolimus ointment How to use tacrolimus ointment Getting the most from your treatment Can tacrolimus ointment cause problems?

How to store tacrolimus ointment Important information about all medicines. Tacrolimus ointment Protopic In this article About tacrolimus ointment Before using tacrolimus ointment How to use tacrolimus ointment Getting the most from your treatment Can tacrolimus ointment cause problems? Very common tacrolimus ointment side-effects these affect more than 1 in 10 people What can I do if I experience this?

A burning sensation, itching These symptoms generally disappear within one week Common tacrolimus ointment side-effects these affect fewer than 1 in 10 people What can I do if I experience this? Redness, a feeling of warmth, pain, increased skin sensitivity to heat and cold, tingling, rash, local skin infections, cold sores If any continue or become troublesome, speak with your doctor.

If you have any questions about this medicine ask your pharmacist. Are you protected against flu? Further reading and references. Related Information Atopic Eczema Clobetasol propionate for severe inflammatory skin conditions ClobaDerm, Dermovate, Etrivex Clobetasone butyrate for inflammatory skin conditions Clobavate, Eumovate Hydrocortisone butyrate for severe inflammatory skin conditions Locoid Mometasone for severe inflammatory skin conditions Elocon.