The topical immunomodulators tacrolimus and pimecrolimus have proven effective in managing atopic dermatitis.1,2 Reported adverse effects are infrequent and most often consist of transient burning, warmth, or erythema at the application site upon initial use.1,2 We recently identified 3 patients who experienced application site erythema following the consumption of alcohol after using topical tacrolimus or pimecrolimus for the treatment of facial dermatoses. While this reaction has sometimes been mentioned for topical tacrolimus,3 there are no reports in the literature of this effect occurring with topical pimecrolimus. To study potential ways of alleviating this unwanted response, we conducted a double-blind controlled evaluation of 2 of the 3 patients after blocking 2 important mediators of vasodilatation, histamine and prostaglandins.
Ehst BD, Warshaw EM. Alcohol-Induced Application Site Erythema After Topical Immunomodulator Use and Its Inhibition by Aspirin. Arch Dermatol. 2004;140(8):1014–1015. doi:10.1001/archderm.140.8.1014
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