Protopic Ointment (Acrolimus) vs. Topical Hydrocortisone

Protopic ointment vs. hydrocortisone: What’s the difference?

• Protopic ointment (acrolimus) and hydrocortisone are topical drugs (for the skin) used to treat atopic dermatitis (eczema).
• Hydrocortisone is also used for the relief of itching and inflammation caused by a wide variety of skin conditions (for example, insect bites and allergic reactions).
• Protopic Ointment and hydrocortisone belong to different drug classes. Protopic ointment is an immunosuppressive and hydrocortisone is a corticosteroid.
• Side effects of Protopic Ointment and hydrocortisone that are similar include application site reactions (burning, itching, irritation, and dryness).
• Side effects of Protopic Ointment that are different from hydrocortisone include flu-like symptoms, allergic reactions, and headache.

What is Protopic ointment? What is hydrocortisone?

Protopic ointment (acrolimus) is an immunosuppressive topical drug (for the skin) used to treat atopic dermatitis (eczema). Atopic dermatitis is a chronic (long-lasting) disease of skin in which the skin becomes inflamed, causing itchiness, redness, swelling, cracking, weeping, crusting, and scaling. The inflammation is caused by activation of the immune system though the reason for the activation is unknown. Protopic ointment suppresses the immune system and the inflammation by inhibiting an enzyme (calcineurin) crucial for the multiplication of T-cells, cells that are required for activation of the immune system.

Hydrocortisone is a corticosteroid used for the relief of itching and inflammation caused by a wide variety of skin conditions (for example, insect bites, allergic reactions and eczema). Hydrocortisone works by preventing skin cells from releasing chemicals that produce irritation or allergic reactions. This reduces the redness, swelling, and itching.

Eczema
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What are the side effects of Protopic and hydrocortisone?

Protopic

The most common side effects of tacrolimus ointment are skin reactions at the site of use, including:

• redness,
• burning,
• itching,
• Flu-like symptoms,
• allergic reactions, and
• headache.

Continuous long-term use of tacrolimus should be avoided because rare cases of skin cancer and lymphoma have occurred during tacrolimus treatment.

Hydrocortisone

The most common side effects of hydrocortisone valerate are:

• burning,
• itching,
• irritation, and
• dryness at application sites.

Side effects are more frequent when occlusive dressings or large quantities are applied. Applying corticosteroids to infected skin may worsen the infection. Long-term use may lead to atrophy of the skin and pigmentation changes. Prolonged use of hydrocortisone can depress the ability of the body's adrenal glands to produce corticosteroids. Abruptly stopping hydrocortisone in these individuals can cause symptoms of corticosteroid insufficiency, along with:

• nausea,
• vomiting, and
• shock.

Hydrocortisone valerate has produced mild, reversible suppression of corticosteroids in adult patients when administered for 5 days and the area was covered (occluded); when 15 grams was applied twice a day to over 25% to 60% body surface area; or when applied three times a day to over 20% to 30% body surface area for 3-4 weeks.

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What is the dosage for Protopic and hydrocortisone?

Protopic

Tacrolimus ointment is applied to the affected areas of skin twice daily. The 0.1% concentration of tacrolimus ointment is approved for the treatment of adults, while the 0.03% concentration is approved for the treatment of both children (ages two and older) and adults.

Hydrocortisone

Westcort should be applied sparingly to affected areas once or twice daily. The minimum effective amount should be used.

What drugs interact with Protopic and hydrocortisone?

Protopic

No studies have been done to determine if tacrolimus ointment has important interactions with other drugs. Interactions are unlikely because only small amounts of tacrolimus are absorbed from the skin; however, it still is possible that important interactions might occur.

Hydrocortisone

No significant drug interactions have been described with hydrocortisone valerate.

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Are Protopic and hydrocortisone safe to use while pregnant or breastfeeding?

Protopic

• Only small amounts of tacrolimus are absorbed from the ointment, and it is not known if these amounts are toxic to the fetus. Among women who have received oral tacrolimus while pregnant, high potassium levels and kidney injury have been reported in their newborns. Therefore, tacrolimus ointment should be used during pregnancy only if the benefits outweigh the potential risks to the fetus.
• Only small amounts of tacrolimus are absorbed from the ointment, and it is not known how much, if any, appears in breast milk. However, it is known that tacrolimus, when taken orally, passes into breast milk. Consideration should be given to discontinuing either breastfeeding or tacrolimus ointment in nursing mothers.

Hydrocortisone

• The use of hydrocortisone valerate in pregnant women has not been adequately evaluated.
• It is not known if hydrocortisone valerate is secreted in breast milk.