Topical calcineurin inhibitors

Topical calcineurin inhibitors (pimecrolimus and tacrolimus) are a class of eczema medication. They help to suppress the signs and symptoms of eczema (itching, redness and inflammation) which are a reaction caused by a local immune response. They are applied to the skin twice daily for as long as the signs and symptoms persist.

Health Canada issued a Public Health Advisory in 2005, advising Canadians about the appropriate use of these products. The advisory stressed that these medications should be used according to approved labelling (i.e., the instructions provided by the manufacturer and approved by Health Canada).

Over a decade has passed since then, though the role of topical calcineurin inhibitors in the development of cancer is still uncertain. There is no clinical evidence of an increased rate of certain cancers when compared to the general public.

While numerous studies have shown that topical calcineurin inhibitors are safe and effective, it's still important to use these medications exactly as directed by your physician:

  • Pimecrolimus and tacrolimus should be reserved for cases where other eczema treatments are inappropriate or ineffective.
  • These medications should not be used for children under two years of age because the effect on the developing immune system is unknown.
  • Use only the appropriate amount of medication needed to control your eczema symptoms.
  • These medications should only be used for short-term and long-term intermittent treatment (short treatment periods with breaks in between treatments) as directed by your doctor. They are not intended to be used continuously.
  • People with weakened immune systems should not use these medications.

If you are concerned about your risk of cancer or would like more information, talk to your doctor or pharmacist.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Eczema-Treatments-Long-term-Safety

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Topical corticosteroids

Topical corticosteroids are a group of eczema medications that work by reducing inflammation by suppressing immune system activity around the treated area. They are applied to the affected skin areas, usually once or twice daily.

How safe are these medications in the long term?

The answer depends on which corticosteroid is used and how you use it. The following things can increase your risk of side effects from topical corticosteroids, especially over the long term:

  • using a strong topical corticosteroid (such as betamethasone dipropionate, clobetasol, halobetasol, betamethasone valerate, halcinonide, fluocinolone, fluocinonide, diflucortolone, dexamethasone, amcinonide, or betamethasone valerate)
  • applying the medication to a large body area
  • covering the medication with an airtight dressing
  • using the medication for a long period of time (this period depends on the medication used, the size of the area being treated, and the use of airtight dressings)
  • using the medication on areas of the body that have thin layers of skin such as eyelids, face or groin

The long-term side effects of corticosteroids can be divided into local (affecting the skin) and systemic (affecting the whole body).

Local effects:
  • skin atrophy (thinning of skin), leading to pale, wrinkled skin with visible blood vessels
  • stretch marks
  • increased growth of body hair
  • loss of pigment (colour) in small areas of the skin
  • impaired wound healing
  • skin irritation
  • red spots on the skin
  • acne or rosacea (a condition causing facial flushing): may occur if topical corticosteroids are used on the face
  • telangiectasia (spider veins)
Systemic effects:
  • glaucoma or cataracts: more common if the medication is used near the eye
  • stunting of growth
  • weight gain
  • body changes: moon face (face becomes rounder and more moon-shaped) and buffalo hump (fat deposits on the back that look like a buffalo's hump)
  • weakened immune system

It's important to understand that not everyone will experience these side effects after using topical corticosteroids. Because your risk of these long-term side effects depends on which medication is used and how it is used, check with your doctor to make sure you or your child are using the medication appropriately. Your doctor may recommend that you use a weaker steroid, or that you use short treatment periods followed by "holidays" where no steroids are used, or that you try a different medication.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Eczema-Treatments-Long-term-Safety

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Systemic Medications

For many people, eczema does not improve much after topical treatment with ointments or creams. In severe cases, oral immunosuppressants (eg., cyclosporine, azathioprine) or monoclonal antibody drugs can be used. Dupilumab is a monoclonal antibody approved to treat moderate to severe eczema, and is administered by subcutaneous injection every other week.

Systemic therapies often act on the immune system to ease eczema over large areas of the body. There are many systemic medications available on the market, including cyclosporine, mycophenolate, methotrexate, and azathioprine. Since these medications work on the entire body, they are far more effective than topicals but can also cause more side effects:

  • Systemic medications can increase the chance of having an infection by suppressing the immune system.
  • Cyclosporine can cause kidney damage and requires close monitoring. It should not be given continuously for more than two years.
  • Azathioprine is relatively well tolerated, but prolonged use can cause liver and bone marrow toxicity.

These side effects can be minimized with proper use.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Eczema-Treatments-Long-term-Safety

Phototherapy

Phototherapy uses ultraviolet (UV) light to treat some of the more severe types of eczema. It is believed to work by altering the body's immune response. Although UV light is effective for eczema, it can also cause long-term side effects similar to those caused by too much sun (since the sun also gives off UV light).

Like excess sun exposure and tanning beds, phototherapy can cause long-term skin damage. The main long-term side effects of phototherapy are skin cancer and photoaging of skin. Photoaging is the premature aging of skin caused by exposure to UV light (through tanning beds, the sun, or phototherapy). Photoaging causes skin thinning, sagging, wrinkling and "liver spots."

If you are concerned about your risk of skin cancer or photoaging, talk to your doctor. Your doctor can suggest ways to minimize your risk, such as making sure that all unaffected areas are protected from UV light during treatment, selecting a different method of phototherapy, or using the minimum amount of phototherapy needed for successful treatment.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Eczema-Treatments-Long-term-Safety