The report1 citing topical tacrolimus as benefiting patients with Zoon balanitis is another uncontrolled application of this topical immunomodulator for various diseases of the skin, including recalcitrant facial erythema, actinic dermatitis, cheilitis, facial psoriasis, and lichen sclerosis et atrophicus.2- 5 All of these dermatologic entities were treated with topical and/or systemic corticosteroids prior to the treatment with tacrolimus. In view of our findings6 that corticosteroid-addicted (those with especially atopic dermatitis) individuals have ongoing severe erythema as a result of vascular dilatation caused by excess nitric oxide, this factor should be addressed before value is given to any immunomodulator benefit.
Rapaport MJ. Topical Tacrolimus. Arch Dermatol. 2005;141(11):1468. doi:10.1001/archderm.141.11.1468-a