Atopic dermatitis (eczema)

Pimecrolimus (Elidel) is an immunosuppressant derived from Ascomycin. Ascomycin is produced by the fungus Streptomyces hygroscopicus. Topical Pimecrolimus (Elidel) become available for prescription around 2001.

Pimecrolimus (Elidel) cream comes in one strength (1%) and is available in 30g, 60g and 100g tubes. The most important use for Pimecrolimus (Elidel) cream is to treat Atopic Dermatitis. The manufacturer recommends that Pimecrolimus (Elidel) should only be used for age 2yr and older, but is has been used successfully in younger children.

Pimecrolimus (Elidel) works by inhibiting the molecule Calcineurin that is essential for activating T-lymphocytes. T-lymphocytes, which are white blood cells, play an active role in Atopic Dermatitis. When T-lymphocytes become activated they help to induce a flare-up of Atopic Eczema.

Pimecrolimus (Elidel) is most often used as a third line treatment for Atopic Dermatitis. First line treatment is emollients and second line treatment is topical corticosteroids. Pimecrolimus (Elidel) is often prescribed when it is difficult or impossible for eczema-sufferers to wean themselves of topical corticosteroids. The extra immunosuppressive effect of the Pimecrolimus (Elidel) should allow most patients to reduce the topical corticosteroids needed to control the dermatitis. A comparison of Pimecrolimus (Elidel) with Tacrolimus 0.03% showed no significant differences in efficacy at 6 weeks after treatment started. Tacrolimus 0.1% is more potent that Pimecrolimus (Elidel) and 0.03% Tacrolimus.

Side effects from using Pimecrolimus (Elidel) cream are mild. About 4% of people using Pimecrolimus (Elidel) will experience a burning or stinging sensation where they apply the Pimecrolimus (Elidel). The burning sensation disappears in about 15 minutes. It only occurs in the first week or two and in active patches of dermatitis.

The long-term risks (years) of using Pimecrolimus (Elidel) is unclear. The biggest concern about Pimecrolimus (Elidel) cream is that it might raise the risk of developing skin cancers. People using Pimecrolimus (Elidel) cream should limit their exposure to sunlight. In animal studies Pimecrolimus (Elidel) speeded up the cancer-forming effects of sunlight.

There have so far been 10 people that have developed a skin cancer while using Pimecrolimus (Elidel). Four of these were skin lymphomas. The skin cancers occurred on average 90 days after the start of therapy. It is unclear if Pimecrolimus (Elidel) caused the skin cancers or whether the skin cancers would have developed anyway.

Until long-term data becomes available Pimecrolimus (Elidel) will probably remain an important third line treatment for eczema-sufferers finding it difficult or impossible to wean themselves of topical corticosteroids.