Off-label Uses of Topical Calcineurin Inhibitors

Eric Wong, MD; Anil Kurian, MD


Skin Therapy Letter. 2016;21(1) 

In This Article

Abstract and Introduction


Topical calcineurin inhibitors (TCIs) have been proposed as an alternative, long-term treatment option to topical corticosteroids, without the side effects commonly associated with steroid use. Currently, TCIs are only approved for treatment of atopic dermatitis in patients 2 years of age or older. This article reviews the off-label uses of TCIs and their efficacy in the treatment of cutaneous diseases. Studies show that TCIs may be effective in treating/managing a variety of skin conditions. The strongest evidence based support on clinical outcomes has been reported for allergic contact dermatitis, lichen planus, psoriasis, seborrheic dermatitis and vitiligo.


The potential side effects of long-term topical corticosteroid use have propelled the need for an alternative treatment option. Topical calcineurin inhibitors (TCIs) have been proposed as a potential substitution. There are two common topical drug forms available: tacrolimus 0.03% or 0.1% ointment and pimecrolimus 1% cream. Currently, the use of tacrolimus in Canada has been indicated for treatment of patients with moderate to severe atopic dermatitis in those 2 years of age or older. TCIs work by inhibiting the protein, calcineurin phosphatase, thus reducing cytokine production and T-cell activation. Their mechanism of action is attributed to immunomodulatory and anti-inflammatory properties. These medications have been thought of as a potential and viable alternative due to their mild cutaneous and minimal systemic side effects. Moreover, patient compliance may be enhanced as these are steroid sparing agents. In this article, we will discuss the off-label uses of TCIs with the greatest support.[1,2]