Protopic and Elidel for Psoriasis

Strength Without Steroids

Woman with doctor
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Psoriasis is a common skin condition that changes the life cycle of skin cells. Psoriasis causes cells to build up rapidly on the surface of the skin. The extra skin cells form thick, silvery scales and itchy, dry, red patches that are sometimes painful.

Psoriasis is a persistent, long-lasting (chronic) disease. There may be times when your psoriasis symptoms get better alternating with times your psoriasis worsens.

Protopic and Elidel for Psoriasis

The primary goal of treatment is to stop the skin cells from growing so quickly. While there isn't a cure, psoriasis treatments may offer significant relief. 

But here's a dilemma: You need to treat psoriasis on an area where strong topical steroids may be a problem, but milder corticosteroids are ineffective. What should you do? One easy solution is to use a non-steroid topical medication. However, many of these, such as Dovonex or Psoriatec are typically too irritating to use on sensitive facial or groin skin. For a solution, we have to look outside the list of FDA-approved psoriasis drugs and utilize some drugs used and approved for eczema. Using an approved drug for an unapproved use is called "off-label" use and it's not only perfectly legal, it's actually quite common in dermatology practice. Such drugs are Protopic (tacrolimus) and Elidel (pimecrolimus).


Protopic is an ointment which can be useful for psoriasis of the face and groin. One unusual side effect of Protopic is that areas treated become red upon ingestion of alcohol -- something which patients may have brought to their attention at a dinner party if they are not warned of this beforehand.


Elidel works like Protopic, but its cream base is less greasy and perhaps a bit more comfortable (although it may not be quite as effective for this condition). Both drugs are excellent for inverse psoriasis of the skin folds. They also both may cause a bit of mild stinging with initial use. Several years after their release, both drugs received a "black box" warning regarding risks of infection or malignancy. The American Academy of Dermatology and others have gone on record with the position that the drugs are indeed safe when used appropriately.

Whether or not off-label use of these drugs is right for you is a decision you and your dermatologist have to make together. At times, insurance companies are reluctant to cover the use of these relatively expensive drugs when cheaper steroids are available. However, a letter from your dermatologist indicating the specific need for a non-steroid drug in a given circumstance may get the drug approved.


Mayo Clinic. Psoriasis.