Is Protopic (Tacrolimus) Effective?

[Gary]

I was reading this product description and it seems impossible to do what the manufacturer is claiming it's treatment can do.

I'm sure a few of your have used this treatment for your eczema.  What were your experiences with it?

Tacrolimus ointment is a topical ointment applied to the skin. It is not a steroid. Tacrolimus ointment is an immunomodulatory drug, which means it modulates or 'changes' the immune system in some way. In this particular case it dampens down the body's immune system, which normally provides protection from infection from the outside world but in atopic eczema the immune system is overactive and needs a helping hand.

Atopic eczema is a skin condition where the body reacts to things in the environment, which would normally do it no harm. This means that the immune system is fighting things such as the house-dust mite and pollen allergens, which in turn causes the skin to become red, itchy and inflamed.

Tacrolimus ointment acts on the cells in the body and the skin to dampen down the immune system. This will help to reduce inflammation and make the skin less itchy and red.

How the heck would a topic cream act as an autoimmune suppressor?

[MarieC]

I had to do a drug monograph/presentation for my rx tech class about 2 years ago and I picked this drug. I had to research the Mechanism of Action in depth...it's been awhile...but the drug supposedly works on the T-cells in the skin by preventing them from producing a certain calcium (calcineurin which is released when the T-cell is activated from an allergen) from binding to a certain protein in the T-cells. If these are formed inflammatory cytokines are released from the T-cell and cause the itch and inflammation. The drug "suppposedly" inhibits that. Don't know if that helps much.

For me the drug sent me into remission for about a year and a half or so about 2 years ago. It isn't even half as effective as it was when I first started using it, but I do use it once in awhile.

[Gary]

Thanks for the explaination - but still - how does it affect T-Cells without being injected?  T-Cells are in your blood, not your skin.

Is it even possible for a topical compound to penetrate into the blood system without actually having internal access to the circulartory system?

This is the thing I don't understand.

[MarieC]

Yeah I know what you mean. I guess some (not sure how much) is absorbed in the bloodstream, like with topical corticosteroids, they act by coating T-cells and preventing them from performing their actions so I'm sure they are absorbed systemically to an extent.

[Gary]

To be perfectly honest with you, I'm still skeptical.

To my knowledge, you don't really want a topical steroid to go into your bloodstream - and the only way of getting it to do so would be to cover a large area of your body with it, or to occlude the area you're treating.

I guess with occlusion, it's possible for ProTopic to enter the bloodstream, but it sound hokey to me.

I mean, I'm not a doctor, but I do have an advanced level of knowledge on the subject and i've never heard of a topical, the main function of which is to penetrate through to the patient's bloodstream to buffer T-Cells.

Isn't that why biologic injections exist?  Weird.

[Dapper]

It does get absorbed systemically, although (supposedly) minimally.  I got put on the stuff right before it came to market, and my dermatologist said one of the best things about the drug is that it is a large molecule that does not permeate past the skin easily. 

Apparently, T-cells are in the skin and presumed to be acted on by the protopic, but doctors are not sure exactly what the mechanism of protopic is: http://www.protopic.com/professional/science/moa.php?page=science&subPage=moa

It's not surprising they wouldn't understand the mechanism exactly -- the whole mechanism of itch itself is only poorly understood, from what I have read, let alone allergy reactions in general.

As for the drug's effectiveness, I don't think that's really up for debate.  In my own case, I had quite severe atopic dermatitis my entire life, never responded well to topical steroids, never found anything to really control it at all other than prednisone, until in my mid 20s I got on protopic right before it came on market.  With 80-90% of my skin surface covered in eczema when I started, my eczema was effectively cured within a month or two, although it took another couple years for my skin to mostly heal.  Since then I basically don't have eczema anymore, although my skin is still symptomatically extremely dry and sensitive so I have to pay attention to that.  If I cut back the protopic my eczema flares up again.

For me it has been nothing short of a miracle drug.

ADDED: One funny thing, though, is when I get patches of dyshidrotic eczema, the protopic doesn't really do anything for them but topical steroids usually do (opposite of the pattern for my normal eczema).  It's strange, but my derm was aware of this difference and told me I would probably have better luck with the steroids on the dyshidrotic eczema.  *shrugs*

[lurker]

Gary,

  My impression is that the capillaries in the skin carry the T-Cells to the skin and therefore once the T-cells encounter an allergen they will react.  A topical application such as protopic will suppress the T-Cell action in a localized area around the application site.

  Logically speaking, nutrients get carried to all organs of your body somehow, and that somehow is the circulatory system.  T-cells travel via the same system, they get to the skin.  If blood doesn't get to the skin how does the skin get nourished by the body?  It would just die wouldn't it?

  Where is Sundog when you need him?   Ack, forget him, I'll look at some of my school books later...

    - lurker