Dr. Alan Greene on Protopic Risks
What are the possible side effects of Protopic?
My daughter was put on Protopic for eczema. The doctor said that there is no systemic absorption, so there are no side effects. My question is, if there is no absorption, how can it modulate the immune system?
Protopic is the new "wonder drug" of dermatology. Instead of stronger and stronger steroids, there is now a different option. It works well and does not seem to have short-term side effects. However, the oral form of the drug is, basically, chemotherapy, a strong immune modulator (not generally for eczema). The topical form is far gentler but a bit is still absorbed and we don't really know what the long-term effects will be.
At Stanford, the dermatologists are certain that it will prove safe, and hand it out frequently. At UCSF, a top medical school, the head of dermatology is concerned that it could increase the risk of skin cancers or melanoma 20 years down the line.
We know that the oral form can cause lymphoma (though it is still useful for serious conditions) and that the cream has been associated with swollen lymph glands. Patients are supposed to be warned to see the doctor immediately for swollen glands while on Protopic cream. I don't prescribe Protopic lightly, but only use it for severe eczema to break the cycle. I may be overly cautious. All agree that it works well and has few short-term side effects. Protopic ointment is not recommended for nursing mothers because it does get in the breast milk, where babies get it orally.
The most common food triggers for eczema are milk, eggs, nuts, peanuts, fish, shellfish, and wheat.
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