Protopic (tacrolimus ointment) and Elidel (pimecrolimus cream) are topical calcineurin inhibitors. They calm the immune response in the skin that drives eczema. Neither contains a steroid.
At a glance
| Protopic (tacrolimus) | Elidel (pimecrolimus) | |
|---|---|---|
| Type | Topical calcineurin inhibitor | Topical calcineurin inhibitor |
| How it works | Calms immune cells in the skin | Calms immune cells in the skin, with a milder effect |
| Used for | Eczema on the face, folds and long-term sites | Mild to moderate eczema on thin or sensitive skin |
| Form | Ointment | Cream |
| How fast it works | Often days to a few weeks | Often a few weeks |
| Common side effects | Burning or itching when you start, warmth, redness | Burning or itching when you start, mild redness |
| Pregnancy | Talk to your clinician before use | Talk to your clinician before use |
| Monitoring | Skin check-ins, no routine blood tests | Skin check-ins, no routine blood tests |
Strengths, ages and schedules are set by your clinician.
How each works
Eczema flares when immune cells in the skin overreact. Tacrolimus and pimecrolimus block a key step in that reaction. The skin becomes less red, itchy and inflamed.
They do not thin the skin. That is why clinicians use them on the face, eyelids, neck and folds. They also work well for areas that need long-term control.
Which may suit whom
Protopic may suit you if your eczema is moderate, or if milder products did not give enough relief. Its ointment base is rich, which helps dry, cracked skin. Some people find the ointment greasy.
Elidel may suit you if your eczema is mild to moderate and sits on thin or sensitive skin. The cream is lighter and easier to apply to the face. It is less strong, so it may not be enough for stubborn patches.
Many people use a steroid for a short flare and then switch to one of these for upkeep. Your clinician reviews your photos and history, and decides what fits.
Safety
Both can cause burning or itching in the first days. It often fades as the skin heals. Tell your clinician if it does not.
Avoid sun lamps and tanning beds. Limit sun on treated skin, and use sunscreen on those areas when your clinician says it is safe. Do not use either product on infected skin or if your immune system is weak. Their long-term safety is still being studied, so keep to the time your clinician sets.
Tell your Care Team about any new lump, sore that does not heal, or change in skin color on the treated area.
Can they be used together?
You do not normally use both on the same patch. They act in the same way, so adding the second gives no clear gain. Your clinician may give Protopic for one area and Elidel for another, or add a moisturizer and a short steroid course.
Do not combine products on your own. Ask your Care Team first.
Cost and coverage
The cost depends on the product, the tube size and your pharmacy. Each consultation costs CA$175.
Provincial drug plans may cover these products only with a special authorization form. Private plans vary. Your Care Team can help with the form. See our insurance page.
Next step
Share photos and your history with Modern Dermatology. A Canadian-licensed medical professional will review them and tell you which option, if any, is right for you.
