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Column originally published Jul 27, 2021

Non-Steroid Cream Can Be Safe And Effective To Treat Eczema

Question: Our one-year-old daughter has a rash on her cheeks for months already. I always blamed it on her drooling. This finally stopped several weeks ago, but the rash is still there. When I took her to see our doctor, he said that it is eczema, and prescribed a cream called Elidel. I grew up with eczema all my life, and have used a lot of steroid creams, but I have never heard of this one. When I went online to search, I saw a warning of cancer risk. I am not comfortable to use it on our daughter. Is Elidel dangerous?


The Elidel cream that your doctor prescribed is perfectly safe. Let me explain this to you.

Eczema, also called atopic dermatitis, is a common skin problem in children. It is an allergy condition, passed on from parents to their children through the genes. It can be present on the cheeks, behind the ears, around the creases in arms and legs. It can be very itchy; sometimes children can scratch themselves to the point of bleeding while asleep.

For the longest time, topical steroid was the standard treatment. Physicians prescribed low potency steroid creams for mild to moderate eczema. If it is severe, more high potency steroid cream is needed. Topical steroid is effective to reduce inflammation in the eczema, but prolonged use, especially on the face, can cause thinning of the skin. This often created a dilemma, because eczema is common on the cheeks, sometimes even on eyelids. Excessive use of high potency steroid can also suppress the adrenal glands. These glands produce cortisol, our body’s own steroid that is essential to sustain us when we are sick.

Several decades ago, a medicine called tacrolimus was discovered that was highly effective in suppressing the immune system. It was used to prevent organ rejection after heart, liver, and kidney transplantations, allowing transplant recipients to enjoy normal lives with their transplanted organs. A small number of them later developed skin cancer and lymphoma, a cancer of the lymphatic system.

Later, scientists put tacrolimus in a cream and called it Protopic: 0.1% for adults and 0.03% for children. Protopic was shown to be safe and effective for mild to moderate eczema without the need of steroid cream. This was followed by 1% pimecrolimus cream (a related chemical); they called it Elidel. It was found to be equally effective in reducing inflammation in eczema.

Several years after their introduction, US FDA (Food and Drug Administration) introduced warning labels on both creams, based on rare occurrence of cancer in those transplant recipients who took tacrolimus by mouth to prevent organ rejection. However, research had shown that there is little absorption of tacrolimus or pimecrolimus when used as topical cream.

Multiple research involving many thousands of children and adults over the past two decades have proven the safety of Protopic and Elidel. In fact, Health Canada has recently approved 1% Elidel cream for children over 3 months of age, further indication of its safety.

Both Elidel and Protopic should be used twice a day for mild to moderate eczema. If eczema is severe, a topical steroid cream may be necessary to reduce the severity before changing to one of these non-steroid creams.