Rosacea-like eruption due to topical pimecrolimus

Area of Science:

• Dermatology
• Immunology

Background:

• Topical calcineurin inhibitors (TCIs) are used off-label for various dermatoses.
• While tacrolimus has been linked to rosacea, pimecrolimus's role is less understood.

Observation:

• A 39-year-old woman developed a rosacea-like eruption after 12 months of pimecrolimus cream for atopic dermatitis.
• The eruption resolved upon discontinuation of pimecrolimus and initiation of oral lymecycline, topical metronidazole, and emollients.

Findings:

• This case adds to the five previously reported instances of pimecrolimus-induced rosacea-like eruptions.
• The findings suggest a potential class effect of TCIs in triggering such reactions.

Implications:

• Dermatologists should consider this rare side effect when prescribing TCIs, especially for facial application in adults.
• Patients using TCIs on the face should be informed about the potential for developing a rosacea-like eruption.