protopic - long term use

[Maxine]

I am a regular user of protopic 0.1% on my face. I have been using it for 8 years. it has really helped my facial eczema which used to be really debilitating, painful, embarrassing.
I have had the useage reviewed by dematolgists a couple of times and we have agreed I can't really stop using it. Without it my face flares up dramatically. I used to use it once a day but have managed to cut down to 3 times a week by using Eucerin daily. I can't see this useage changing. I know there are some risks associated with long term use.

What is ther latest thinking/research about long term use at this fairly low level? Is it safe?
I use factor 50 sun protector on my face every day. Is there anything esle I should be doing to reduce risk? Thanks

[Dr Miriam Wittmann]

Dear Maxine,

topical calcineurineantagonists (protopic, elidel) have been discussed shortly after they were introduced to the US market (in particular for use in children) to act potentially in a way that they may favour some cancer conditions.
At that time there were 2 issues raised
- cancers not related to the skin (lymphoma, in particular in children). Information available today: not really proven. There were one or two publications which suggested an increased risk in children but most observations failed to detect an increased risk.
A recent systematic review summarises the findings from a large number of publications:
Legendre L et al: Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment:
A systematic review and meta-analysis. J Am Acad Dermatol. 2015 Jun;72(6):992-1002.

It is important to mention that both Protopic and Elidel are really poor when it comes to penetration into the skin. The current notion is that they only enter deeper layers of the skin if the skin surface is "damaged" (e.g. by eczema lesions).

- cancers related to the skin.
Again - there is no proven evidence for increased skin cancer (melanoma or non melanoma skin cancer) associated with topical calcineurine antagonists (Tennis P et al., Evaluation of cancer risk related to atopic dermatitis and use of topical calcineurin inhibitors. Br J Dermatol. 2011 Sep;165(3):465-73). It is correct that we recommend not to combine UV light exposure with Protopic/Elidel application and your use of sun blocker seems appropriate.

In summary, when thinking about risk-benefit assessment your prolonged use of Protopic seems safer then any other treatment options (for the face) and, importantly, any increased "cancer" risk for long term use of Protopic has not been proven so far.

Kind regards,
Miriam

[Maxine]

Thank you very much Dr Wittmann - I have never had such a clear concise explanation of the risks before, despite having asked several times. I will continue to use as my use if definitely proportionate to the risks.

Ineresting about the poor penetration - for me it has been a wonder drug, but I did have lots of lesions without it. I guess the poor penetration is good news from the point of view of not having a systemic effect or risk.

Anyway - thank you, and best wishes.