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Ask the Pharmacist By Ron and Marla Chapleau |
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Q) What’s the latest on using the creams Protopic (tacrolimus) or Elidel (pimecrolimus) on children? A) A few years back these two new creams, known as immune modifiers, arrived on the market aimed at treating eczema. Shortly after their use in children was approved, dermatologists had widely prescribed them in the hopes of controlling this chronic skin condition without resorting to using steroid creams, the mainstay of therapy for many years before this. It was hoped that they would minimize the potential side effects of steroid creams in this population. Unfortunately, after a number of years, scientists revised this recommendation when they found the harmful effects of Protopic and Elidel outweighed their benefits in the pediatric population. Both creams seemed to have at least an association with several types of cancer (lymphoma, melanoma etc.) and while a causal relationship has not been proven, it cannot be ruled out either. While it may seem hard to fathom how a cream can cause cancer, one must remember that all creams are at least partially absorbed systemically and children seem to do this to a greater extent than adults do. As a result of this, experts made a number of recommendations including that neither of these creams be used on children under the age of two, that only the weaker strength of Protopic (0.03 per cent) be used on children under 16 years of age, that neither cream be used for longer than one year and that their use be reserved for persistent eczema that fails to respond to other measures or for flare-ups when steroids are being decreased.
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The current recommendations for treatment include starting with emollient moisturizing creams (eg. cetaphil cream and others), eliminating triggers (allergens, soap, etc.) and using steroid creams for flare-ups (mid- to high-potency ones for seven to 10 days and then switching to a mild cream applied daily at first and then weaned down to three times per week, twice a week, etc.). A treatment now being recommended by some dermatologists to help minimize the potential for flare-ups are bleach baths (120 mL bleach to a bathtub filled two-thirds with warm water - this is more diluted than public pools) for 10 minutes twice per week in order to reduce the skin bacteria that can aggravate eczema. For
more information about this or any other health-related questions,
contact the pharmacists at Gordon Pharmasave, Your Health and Wellness
Destination.
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