Tacrolimus may safely replace steroids for eyelid dermatitis. (Avoids Glaucoma Risk).
The problem is not lack of effectiveness--1% hydrocortisone will reliably clear eyelid dermatitis in a day. "For years, we did that. The problem is, it always comes back," said Dr. Lebwohl, professor and chairman of dermatology at Mount Sinai School of Medicine, New York.
Patients tend to save and reuse corticosteroids and seek new prescriptions, often accumulating large total doses. One study details the onset of glaucoma after 3 years of topical steroid application to the eyelids (J. Am. Acad. Dermatol. 8:878-81, 1983).
Some individuals may be particularly at risk. In a study of patients who used corticosteroid eyedrops twice a day for 3 weeks, the dose was so weak that it was equivalent to topically applying the steroid to the eyelids. Intraocular pressure rose in half of all patients, but it rose in 80% of those who had a personal or family history of glaucoma (Indian J. Ophthalmol. 35:141-45, 1987).
A former fellow of Dr. Lebwohl's, Dr. Mei-Hang Tan, recently learned that even a presumably "safer" corticosteroid, fluticasone propionate (Cutivate), penetrates eyelid skin.
Dr. Lebwohl has discontinued using corticosteroids on the eyelids. Instead, he turns to one of the newer immunomodulators.
In a study conducted with Dr. Amy Krupnick and Dr. Giselle Singer at New York University he studied 20 patients with eyelid dermatitis who applied tacrolimus (Protopic) ointment to the affected area daily for 8 weeks.
"By 4 weeks, virtually everyone cleared. Intraocular pressure did not go up at all," he said.
"If you prescribe this, I would encourage you to tell the patients it's going to sting," added Dr. Lebwohl, who receives funding as a lecturer and researcher for Fujisawa Healthcare Inc., the manufacturer of tacrolimus.
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|Publication:||Internal Medicine News|
|Article Type:||Brief Article|
|Date:||Jan 1, 2003|
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