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Related Experiment Videos

Allergic contact dermatitis from tacrolimus.

Daniel W Shaw1, Lawrence F Eichenfield, Tsippora Shainhouse

  • 1Department of Medicine, University of California, San Diego, California 92103-8420, USA. dwshaw@ucsd.edu

Journal of the American Academy of Dermatology
|May 22, 2004
PubMed
Summary
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Allergic contact dermatitis in a child was caused by tacrolimus ointment. This was confirmed by use testing, suggesting low skin absorption due to tacrolimus

Area of Science:

  • Dermatology
  • Allergology
  • Pharmacology

Background:

  • Tacrolimus ointment is a topical immunosuppressant used for conditions like atopic dermatitis.
  • Allergic reactions to topical medications can occur, necessitating accurate allergen identification.

Observation:

  • A 9-year-old boy presented with allergic contact dermatitis attributed to tacrolimus ointment.
  • Diagnostic testing, including double-blinded provocative use testing and patch testing, was performed.

Findings:

  • Tacrolimus was identified as the causative allergen through provocative use testing, with dermatitis appearing after 1 week on the face and 7 weeks on the arm.
  • Patch testing confirmed tacrolimus as the allergen, requiring a 2.5% concentration in ethanol, while controls showed no reaction to 5% tacrolimus.

Related Experiment Videos

  • Low percutaneous absorption through normal skin, potentially due to tacrolimus' high molecular weight, is hypothesized to explain the delayed reactions and high concentration needed for positive tests.

    • Implications:

    • This case highlights the potential for tacrolimus to cause allergic contact dermatitis, even in pediatric patients.
    • The findings suggest that low percutaneous absorption may influence diagnostic test results for tacrolimus and potentially other high molecular weight drugs like neomycin sulfate.
    • Awareness of delayed-type hypersensitivity reactions to tacrolimus is important for clinicians managing patients on this medication.