Treating Eczema: Difference Between Glucocorticoids, Tacrolimus, Pimecrolimus

Author: Gcplive

Source: Center for Drug Evaluation< /p>Eczema is a chronic, recurrent, inflammatory skin disease, usually accompanied by severe itching, which seriously affects the quality of life of patients. Topical treatment is the main method of eczema treatment, glucocorticoids, tacrolimus and pimecrolimus are the three most commonly used topical drugs, what is the difference between them? I. Differences in anti-inflammatory intensityGlucocorticoids have strong anti-inflammatory and immunosuppressive effects. calcineurin inhibitors (tacrolimus, pimecrolimus) inhibit T lymphocyte activation by inhibiting the activity of calcineurin, and have strong effects. Immunosuppressive effects. In addition, it can also inhibit the release of synthesized mediators in skin mast cells and basophils. 1. Topical glucocorticoidsTopical glucocorticoids (TCS) are divided into super potent, potent, Moderate and weak 4 categories. 2.calcineurin inhibitorcalcineurin There are two topical formulations of inhibitor (TCI), tacrolimus and pimecrolimus. In terms of anti-inflammatory effect: 0.1% tacrolimus≈medium-acting topical glucocorticoid; 0.03% tacrolimus > weak topical glucocorticoid. 1% pimecrolimus II. Differences in adverse reactions1. Systemic adverse reactions Glucocorticoids are steroids that can be absorbed through the skin. It can cause systemic adverse reactions (such as adrenal cortical atrophy, etc.) when used for a long time in a large area. Tacrolimus and pimecrolimus are macrolides with low transdermal absorption rate and usually do not cause systemic adverse reactions. 2. Local adverse reactionsTopical glucocorticoids can cause skin atrophy, telangiectasia, hyperpigmentation, and subsequent infection, etc. Tacrolimus and pimecrolimuscan up-regulate the expression of skin barrier-related genes, increase skin moisture content, and reduce transdermal moisture Loss,does not cause skin atrophy. Tender skin:Including face, neck, eye area, armpit, groin, inner thigh, pubic area, etc. We can choose weak glucocorticoid or taco limus and pimecrolimus. It should be reminded that:The adverse reactions of tacrolimus and pimecrolimus are mainly local burning and irritation. Some patients, especially those in the acute phase, cannot tolerate the stimulation of tacrolimus and pimecrolimus. Maintenance therapy with pimecrolimus. The exposure to natural or artificial sunlight should be minimized during the medication process. Two special glucocorticoidsmometasone furoate and fluticasone propionate belong to “soft hormones” . soft hormonesmeans that hormones are poorly absorbed systemically or rapidly absorbed in the skin Catabolism is an inactive degradation product, while the local area retains a high degree of activity, so the systemic adverse reactions are greatly reduced. Mometasone furoate may be used with caution in infants and children. Fluticasone propionate is suitable for children 1 year and older who have not responded to weak corticosteroids. Fourth, the difference between tacrolimus and pimecrolimusThe anti-inflammatory effect of 0.1% tacrolimus ointment is similar to that of medium-acting sugar Corticosteroids, mostly used for moderate to severe eczema. 1% pimecrolimus cream has a weaker anti-inflammatory effect than moderate glucocorticoids, and is mostly used for mild to moderate eczema. “img height class =”responsive” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/CB0BZ6GAshgfYApsIQnwrorjRzhtUQDriaBEdjHpCLff8hWRIfmEmK1jQyV10yqbmmLQj9BJjQmkwLZ3kkkdRzA/640>” img=” V. Treatment process of topical eczema1. Initial treatmentTopical corticosteroids (TCS) is the first-line therapy for the treatment and control of eczema.Drug options: According to the location and severity of the skin lesions, glucocorticoids of sufficient intensity are selected to rapidly control inflammation A moderate-to-low-potency glucocorticoid is recommended for tender skin.Dosage:Once a day, apply to all areas of inflammation, span>Until the dermatitis subsides and the skin returns to normal (usually 1-2 weeks).