Question 1

Is Topical Tacrolimus a steroid?

Accepted Answer

No, absolutely not. Tacrolimus is a Topical Calcineurin Inhibitor (TCI). It works differently from steroids by targeting specific immune cells (T-cells) without causing the side effects associated with long-term steroid use, such as skin thinning (atrophy), stretch marks, or spider veins.

Question 2

Why does my skin burn when I apply it?

Accepted Answer

A burning, stinging, or warming sensation is the most common side effect, affecting about 40-50% of patients during the first few days. This happens because the medication releases a chemical called Substance P from your nerve endings. The burning usually disappears after 3 to 4 days of continuous use.

Question 3

Can I use Tacrolimus on my eyelids?

Accepted Answer

Yes. Unlike topical steroids, which can increase the risk of glaucoma or cataracts if used near the eyes for long periods, Tacrolimus does not raise eye pressure. It is considered the treatment of choice for eyelid eczema.

Question 4

Which strength should I use 0.1 or 0.03%?

Accepted Answer

0.1% is generally prescribed for adults 16+ with moderate-to-severe conditions or thicker skin. 0.03% is FDA-approved for children ages 2-15 and is often preferred for adults with very sensitive skin like the face or genitals to minimize stinging.

Question 5

Can I drink alcohol while using Protopic?

Accepted Answer

You can, but be aware of the Alcohol Flush. About 15-20% of users experience sudden redness, heat, and flushing on their face if they drink alcohol while using the medication. This reaction is harmless and temporary.

Question 6

Does Topical Tacrolimus cause cancer?

Accepted Answer

Extensive long-term studies in humans spanning over 10 years have not found a causal link between topical Tacrolimus and an increased risk of lymphoma or skin cancer. The FDA Black Box Warning was largely based on animal studies and oral transplant data.

Question 7

Can I go in the sun while using it?

Accepted Answer

You should practice sun safety. However, for Vitiligo patients, dermatologists often prescribe controlled sun exposure (e.g., 15 minutes) or UVB phototherapy in combination with Tacrolimus to stimulate repigmentation.

Question 8

How long does it take to work?

Accepted Answer

For Eczema, significant improvement is typically seen within 1 week. For Vitiligo, it takes much longer - you may need to use it for 3 to 6 months before seeing pigment return.

Question 9

Can I use it on my child?

Accepted Answer

Yes, the 0.03% strength is FDA-approved for children aged 2 years and older. It is a preferred alternative to steroids for children needing long-term maintenance.

Question 10

Can I apply moisturizer with Tacrolimus?

Accepted Answer

Yes. Apply your moisturizer first, let it absorb for about 15-20 minutes, and then apply the Tacrolimus ointment. Do not mix them together in your hand.

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