title: Induction of rosaceiform dermatitis during treatment of facial inflammatory dermatoses with tacrolimus ointment.
abstract: BACKGROUND
  Tacrolimus ointment is increasingly used for anti-inflammatory treatment of sensitive areas such as the face, and recent observations indicate that the treatment is effective in steroid-aggravated rosacea and perioral dermatitis. We report on rosaceiform dermatitis as a complication of treatment with tacrolimus ointment.
  
  
  METHODS
  Six adult patients with inflammatory facial dermatoses were treated with tacrolimus ointment because of the ineffectiveness of standard treatments. Within 2 to 3 weeks of initially effective and well-tolerated treatment, 3 patients with a history of rosacea and 1 with a history of acne experienced sudden worsening with pustular rosaceiform lesions. Biopsy revealed an abundance of Demodex mites in 2 of these patients. In 1 patient with eyelid eczema, rosaceiform periocular dermatitis gradually appeared after 3 weeks of treatment. In 1 patient with atopic dermatitis, telangiectatic and papular rosacea insidiously appeared after 5 months of treatment.
  
  
  CONCLUSIONS
  Our observations suggest that the spectrum of rosaceiform dermatitis as a complication of treatment with tacrolimus ointment is heterogeneous. A variety of factors, such as vasoactive properties of tacrolimus, proliferation of Demodex due to local immunosuppression, and the occlusive properties of the ointment, may be involved in the observed phenomena. Future studies are needed to identify individual risk factors.
authors.affiliation: Department of Dermatology, University Hospital, Geneva, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Antille
authors.forename: Jean-Hilaire
authors.initials: JH
authors.lastname: Saurat
authors.forename: Jann
authors.initials: J
authors.lastname: Lübbe
mesh_terms: D000152:Acne Vulgaris / Q000175:diagnosis / Q000188:drug therapy*; D000287:Administration, Topical; D000328:Adult; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000627:therapeutic use; D018570:Risk Assessment; D012393:Rosacea / Q000139:chemically induced* / Q000503:physiopathology; D012494:Sampling Studies; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D009824:Ointments; D016559:Tacrolimus