Eczema (young people)

Eczema treatments: topical immunosuppressants

A few people had used topical immunosuppressants. A well-known example of this is Protopic (tacrolimus). Immunosuppressant creams/ointments don’t contain steroids but were sometimes confused with being one.

Dr McPherson talks about the differences between steroids and tacrolimus creams.

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Yeah. So the steroids have a more kind of general - neither-, both of them we don't know exactly how they work on the body, because even if you, you can see how something works in the lab, we don't know exactly how it works in such a complex inflammation as eczema. And we know that corticosteroids are probably overall slightly more effective than the tacrolimus type medicines particularly for the body. But for areas where you are worried about steroid side effects, such as skin thinning and striae development and you've got very thin skin already, such as the eyelids, then something like tacrolimus is a very good alternative because it reduces inflammation, it's quite targeted, and it can be used safely on those areas without long term risk of skin thinning.
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Aadam used Protopic on his face but found it caused a rash.

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Age at interview: 18
Sex: Male
Age at diagnosis: 1
I remember this cream which usually works on my skin called, Protopic. It’s good because you are actually allowed to use it on the face, whereas steroid creams, it’s a very concerning issue, because the face and the skin on the face is very sensitive. But when I used Protopic on my face, I ended up having a huge like bruised rash across my face and I was really scared to go to school after that, because suddenly I just come to school with a huge brown rash around my mouth and cheek and I was very embarrassed.

Georgia has researched online about topical steroid withdrawal. She’d like to explore other treatment routes with her dermatologist.

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Age at interview: 20
Sex: Female
Age at diagnosis: 4
One thing I’ve come across recently is topical steroid withdrawal and addiction. When I’ve been using, when it got quite severe and I was referred back to my dermatologist, I was put on courses of prednisolone and Trimovate and I’ve had Protopic and Betnovate. Which are all, Protopic isn’t a steroid but they’re quite, the Betnovate and the Trimovate I think are quite potent. And I wanted to stay away from that because, as I mentioned earlier, I like naturally occurring products, something that’s not gonna have serious side effects on my skin. Which, what I’ve been reading up on is skin thinning, it becomes red and it can deteriorate. And it wasn’t really something I’d wanted to, I didn’t wanna go down that route because my skin is already quite red anyway. And I think it, it’s a bit harsh. But after talking with my dermatologist, who wasn’t too happy for me to go down the route without steroids I think. Because it has such a, it does have a really high success rate. I won’t, I won’t deny that. They’ve been using them for 50 years or so and they are really successful with people that have severe eczema. But after reading up on topical steroid addiction and withdrawal, some of the symptoms, such as regularly infected skin, it’s constantly swollen, red. There’s like a scent of iron actually that I noticed on my skin, which is quite odd. And reading up on some of these people who do suffer with it and are going through the withdrawal of it. It’s, it’s quite severe what they go through. Even though s-, steroids are such an easy route to go down. They, you just put it on for about three weeks or so and use it intermittently, and your eczema is gone. But these people are trying to sort of push the toxins and steroids out of their body, and have been for about two or three years. And they’re still going through symptoms of s-, swollen skin, it’s red, it’s cracked, it’s infected all the time. And I don’t think mine is as severe as theirs, possibly because mine is more stress related and my allergies aren’t as bad as theirs. But it is still a route I would like to explore. And I think I would really appreciate it if it was an option that doctors and dermatologists were more prepared to explore. Rather than accepting that the only route is sort of scientific research instead of going down the herbal route. And sort of just allowing a bit more preference from the patient, not necessarily what they’ve found to be successful in the past.
One example of immunosuppressants is Protopic (tacrolimus) creams and ointments. Aadam said he liked that Protopic could be used for eczema on the face (because it isn’t a steroid) but that it gave him a bruise-like rash when he tried it. Maham’s doctor once suggested she try it but another doctor didn’t feel it was necessary. Others, like Georgia, were still worried that strong topical creams would be bad for her health long term. 

Topical immunosuppressant creams can sting when first put on, but this usually stops with continued use. Georgia found that Protopic made her skin sting, get redder and hot at first. 

Sarah heard about Protopic through a friend and hopes to try it on prescription from her GP soon.
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