What are Topical Calcineurin Inhibitors (TCIs)?

We explained in the introduction section that there are two types of flare control creams – steroid creams and TCIs (Topical Calcineurin Inhibitors). TCIs are creams or ointments. There are two types that are often called by their brand names:

• Protopic (tacrolimus)
• Elidel (pimecrolimus)

TCIs are sometimes used for areas of sensitive skin, like the centre of the face or eyelids. They are usually only given to people who:

• need to use flare control cream daily to keep control
• are under the care of a skin specialist at the hospital.

TCIs should not be used if you are pregnant or breastfeeding or you have a health condition that makes your body’s defence system weak.

How do TCIs work?

The body’s defence system works in a different way in people with eczema. It ‘over-reacts’ to things that would not normally harm us, such as soaps and washing-up liquid.

Like steroid creams, TCIs work by calming down the body’s defence system to reduce flare-ups. Like steroid creams, TCIs are not a cure for eczema. They just help you to get control of your eczema when used together with moisturising creams.

Are TCIs safe?

TCIs have not been around as long as steroid creams. They appear to be safe, but it is not yet known what their long-term side-effects might be. For this reason they are used much less than steroid creams.

TCIs may sting or itch when they are first put on. This tends to settle down after a week. Some TCI creams sting more than others. So you may want to ask your doctor or nurse if you can try another TCI cream if yours is stinging a lot.

The area of skin that the TCIs are put on may get red or feel tingly or warm. Some people can get sore red spots after using TCIs. These spots should settle on their own.

There is a small chance that you might get cold sores on the area of skin that the TCIs are put on during the first few weeks of using it.

How are TCIs used?

TCIs are put on skin with eczema, usually twice a day to start with. This may be decreased to once a day after a few weeks. Your doctor, nurse, or pharmacist will tell you how often and when you need to put them on. A thin layer is needed. They should be used until the eczema flare-up has gone. TCIs should not be put:

• up the nose, in the mouth or on internal genital areas
• on infected areas of skin
• on skin with impetigo, chicken pox, cold sores or warts.

It may make these conditions worse. You can find out more about these conditions in the ‘infections’ section, which you can get from the ‘more about treatments’ menu above.

TCIs can react in sunlight or ultraviolet (UV) light. Try to avoid staying out in strong sunlight or using UV lights. This includes light treatments for eczema. You can find out more about light treatments in the ‘other treatments’ section, which you can get from the ‘more about treatments’ menu above.

Can TCIs be used with moisturising creams?

Yes. You will need to carry on using moisturising creams every day to keep control of your eczema.

It is best to leave a gap of 20 to 30 minutes between putting on TCIs and moisturising creams. This is because the moisturising creams may water down the TCI making it work less well.

If you are using Protopic (tacrolimus), it would be better to leave a 2 hour gap if you can. But, we realise that this can be hard to do.

Can TCIs be used with steroid creams?

Yes, your skin specialist may give you both steroid creams and TCIs to put on your eczema. Often these two creams must be put on different areas of the body.

Sometimes, if your eczema is bad, your skin specialist may ask you to use steroids creams on the weekend and TCIs during the week.