title: Pimecrolimus, a topical calcineurin inhibitor used in the treatment of atopic eczema.
abstract: BACKGROUND
  Pimecrolimus , a calcineurin inhibitor, is a non-steroidal treatment option in patients aged ≥ 2 years with mild-to-moderate atopic eczema (AE). It was approved as a viable therapeutic option by the FDA in 2001 and in the European Union a year later in 2002. Calcineurin inhibitors inhibit the synthesis of inflammatory cytokines released from T cells and mast cells. In contrast to corticosteroids, calcineurin inhibitors act specifically on proinflammatory cells. Pimecrolimus shows comparative efficacy to mild topical corticosteroids and a special antipruritic effect. Furthermore, examinations of the systemic absorption of pimecrolimus implicated no systemic immunosuppression. In 2006, the FDA set a black box warning in the packaging materials of pimecrolimus alluding to the risk of skin malignancy or lymphomas due to theoretical consideration.
  
  
  METHODS
  The authors provide a review of pimecrolimus as a treatment for AE. Specifically, the authors present the pharmacokinetic and pharmacodynamic information on pimecrolimus and also review its efficacy. The authors also discuss pimecrolimus' safety and tolerability profile.
  
  
  CONCLUSIONS
  Pimecrolimus represents a valuable part of active and proactive therapy in AE. That being said, the long-term safety of topical calcineurin inhibitors remains to be investigated. Given the results from experimental photocarcinogenicity studies, effective sun protection should be employed during the therapy, although an increased risk for skin malignancies and lymphomas was not found in recent studies. Pimecrolimus should be considered as an alternative therapeutic approach in AE treatment management going along with a corticoid-sparing effect.
authors.affiliation: TU Munich, Dermatology , Biedersteiner Straße 29, Munich 80802 , Germany hanna.prucha@t-online.de.
authors.forename: Hanna
authors.initials: H
authors.lastname: Prucha
authors.forename: Christina
authors.initials: C
authors.lastname: Schnopp
authors.forename: Cezmi
authors.initials: C
authors.lastname: Akdis
authors.forename: Roger
authors.initials: R
authors.lastname: Lauener
authors.forename: Andreas
authors.initials: A
authors.lastname: Wollenberg
authors.forename: Johannes
authors.initials: J
authors.lastname: Ring
authors.forename: Claudia
authors.initials: C
authors.lastname: Traidl-Hoffmann
mesh_terms: D019703:Calcineurin / Q000187:drug effects* / Q000378:metabolism; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004353:Drug Evaluation, Preclinical; D004791:Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012867:Skin / Q000187:drug effects / Q000473:pathology; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics
chemical_list: D003879:Dermatologic Agents; D004791:Enzyme Inhibitors; C117268:pimecrolimus; D019703:Calcineurin; D016559:Tacrolimus