Pimecrolimus
Other dermatological medicines
Other dermatological medicines
A calcineurin-inhibitor cream for atopic dermatitis when other treatments fail or cannot be used; unlike corticosteroids, it does not thin the skin.
Quick facts
- Group
- Other dermatological medicines
- Target
- Calcineurin, through FKBP12
- Used for
- Atopic dermatitis
- Key effects
- Burning · Headache · Eye irritation
- Monitor
- Response of the eczema · Signs of skin infection
- ATC
- D11AH02
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows tacrolimus bound to human FKBP12; pimecrolimus is a close relative that acts through the same immunophilin. Calcineurin is not in this crystal.
Pimecrolimus acts like tacrolimus: inside skin T cells it binds the immunophilin FKBP12, and the complex blocks the phosphatase calcineurin. The transcription factor NFAT then stays inactive, so T cells release less IL-2 and other inflammatory cytokines and the eczema settles. Very little reaches the blood.
- Cream reaches T cells in inflamed skin
- Drug binds FKBP12 and the complex blocks calcineurin
- NFAT stays off; less IL-2 and cytokines
- Itch and eczema settle without skin thinning
Indications
- Atopic dermatitis (second line, short-term or intermittent use) Atopic dermatitis →
Adverse effects
Common
- Burning, warmth, stinging or redness where applied
- Headache, cough, runny nose
- Eye irritation
- Facial flushing after alcohol
Contraindications
- Hypersensitivity to pimecrolimus
- Children younger than 2 years
- Netherton syndrome or widespread red, peeling skin (needs review first)
Key interactions
- Alcohol
- May cause flushing, redness or warmth of the skin.
- Sun lamps, tanning beds and ultraviolet light therapy
- Avoided on treated skin.
What is monitored
- Response of the eczema; treatment stops when the skin clears
- Signs of skin infection or herpes at the treated sites
- Review if there is no improvement or the eczema returns
Administration and safety
- A thin layer is applied only to affected skin while symptoms are present, and stopped when they clear.
- Treated skin is not covered with bandages, dressings or wraps.
- Kept away from the eyes and mouth.
- Moisturisers go on after the cream has absorbed; swimming or bathing right after application is avoided.
Pregnancy and breastfeeding
Data are limited; pregnancy and breastfeeding are discussed with the treating team before use.
Nursing care
- Check the skin for crusting, oozing, blisters or cold sores before starting.
- Teach sun protection and avoidance of tanning beds and ultraviolet treatment.
- Explain that mild burning is common at first; persistent burning is reported.
- Teach to report fever, swollen neck glands, blisters or signs of skin infection.
Pharmacokinetics
- Absorption
- Applied to the skin; systemic absorption is low to negligible
Test yourself
Think of the answer, then tap the question to see it.
Which enzyme does pimecrolimus block, and through which protein?
Calcineurin, after binding the immunophilin FKBP12 (like tacrolimus).
What is the main advantage of pimecrolimus over topical corticosteroids on the face and skin folds?
It does not cause skin atrophy.
Below what age is pimecrolimus not used?
Children younger than 2 years.
Connections
← Back to the class: Other dermatological medicines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Pimecrolimus Topical: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2016); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.