Tacrolimus ointment for eczema

Name of medicine

Tacrolimus ointment

Brand names: Protopic ointment; tacrolimus ointment

Why is it important for my child to take Tacrolimus ointment?

Tacrolimus ointment may be prescribed for children who have moderate or severe eczema when the standard treatments have not helped. Tacrolimus is an immunosuppressant, meaning that it dampens down the immune system. The ointment works primarily on the skin so it should not affect most of your child’s immune system.

Tacrolimus is used for short periods to treat active eczema flares. It may also be used from time to time for longer periods to prevent flares in children who have many.

When should I give Tacrolimus ointment

This depends on whether treatment is for active flares or to prevent flares, as explained below.

For children with active flares

Tacrolimus ointment is usually applied twice each day. This should be once in the morning and once in the evening. Ideally, these times are 10–12 hours apart, for example some time between 7 and 8 am, and between 7 and 8 pm.

Try to apply the ointment at about the same times each day so that this becomes part of your child’s daily routine, which will help you to remember.

For active flares, tacrolimus ointment is usually used for up to 3 weeks. However, you may be told to use it for longer than this, depending on how bad your child’s eczema is.

To prevent flares

If tacrolimus ointment has been prescribed to prevent flares, it is usually applied twice each week to the areas of skin most commonly affected. Choose two convenient days that are at least 3 days apart (e.g. Monday and Thursday). It can be helpful to put reminders in your diary or phone.

If you child has bad flares, you may be told to apply tacrolimus ointment more often than twice a week.

How much should I give?

Your doctor will work out the amount of tacrolimus (the dose) that is right for your child. The dose will be shown on the medicine label.

The amount of ointment may be described in “fingertip units” – this is the amount of ointment or cream that just covers the top section of an adult finger.

How should I give Tacrolimus ointment?

• If your child is also using steroid cream or ointment, this should be applied at a different time of day from the tacrolimus ointment.
• Make sure the skin where you want to apply the ointment is clean and dry. Do not apply any other creams or emollients to this area for at least an hour before or after applying the tacrolimus ointment, to help it work better.
• Wash your hands thoroughly with soap and hot water before and after applying the ointment.
• Squeeze out the right amount of ointment onto your finger. Spread it in a thin layer so that you can see a shiny film. Do not rub the ointment in as you may irritate the skin.
• Avoid getting the ointment inside the nose or mouth or in the eyes. If the ointment gets on any of these areas, wipe it off thoroughly and/or rinse with water.
• Do not cover the treated skin with bandages or wraps.

When should the medicine start working?

The ointment starts to work immediately but it may take a few days or weeks before you see any difference. It is important to continue applying the tacrolimus as you have been told you during this time.

What if my child is sick (vomits)?

You do not need to worry if your child is sick, as the medicine will still work.

What if I forget to give it?

If you forget to apply the ointment, do it as soon as you remember and then continue as before.

What if I give too much?

You are unlikely to do harm if you apply too much ointment by mistake.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

Other side-effects you need to know about

• • Your child may get a burning sensation or itching where the tacrolimus ointment is applied. This should improve after a few days. It may help to apply a smaller amount of ointment to smaller less inflamed areas first, then build up the amount gradually.
  • Your child may get redness, warmth, tingling or pain in the areas where the ointment is applied and the skin may be more sensitive, especially to hot and cold.
  • They may get a rash.
  • They may get a flushed face.
  • If your teenage child drinks alcohol, the skin may feel more irritated.
  • Your child may be at more risk of skin infection such as inflamed or infected hair follicles, cold sores and more widespread herpes simplex infection. If there is any crusting or blisters on the skin, do not apply tacrolimus ointment to these areas and contact your doctor for advice.

Your child may sometimes get side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side-effects to the UK safety scheme at mhra.gov.uk/yellowcard.

More information on side-effects can be found in a leaflet on our website.

Can other medicines be given at the same time as Tacrolimus ointment?

You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.

Potential fire risk

Tacrolimus ointment contains a small amount of paraffin which may become a fire hazard if dried ointment is allowed to build up on fabrics. While the risk is low, you can take steps to keep your child safe.

• Your child should stay away from naked flames (e.g. candles, gas burners, open fires) and anyone who is smoking. You should also be extra careful after applying the ointment to your child’s skin. Wash your hands thoroughly after.
• Change clothing and bedding frequently, as the paraffin can get dried into the fabric. Wash these at the highest temperature recommended by the manufacturer, although it may not completely remove the danger.
• Make sure that areas of skin treated with tacrolimus do not come into contact with soft furnishings and furniture, in case it leaves traces of paraffin. Note that the tacrolimus itself is not a fire hazard, and will not catch fire in the container or when applied to the skin. The risk is only with a build-up of paraffin on fabric. You can continue to use tacrolimus and other emollients safely for your child’s skin condition. This safety risk applies to all emollients used to treat skin conditions. You can read more on our website here.

Is there anything else I need to know about this medicine?

• Tacrolimus may increase the risk of sunburn. Your child should avoid strong sunlight. Protect their skin with clothing and high-factor sunscreen (at least SPF 50).
• If your child is offered ultraviolet phototherapy, tell the healthcare professional that your child is using tacrolimus ointment.
• Tacrolimus medicine is also used to prevent the rejection of transplanted organs and for a condition called nephrotic syndrome. It is given by mouth (as capsules or granules) for these conditions. Information in the public domain may relate to this use rather than to the use of the ointment for eczema or other skin conditions.
• If there is any change in the appearance of your child’s eczema, contact your doctor or nurse.
• Tell the doctor if the person who will applying the ointment is pregnant or breastfeeding.

General advice about medicines

• Only give this medicine to your child. Never give it to anyone else.

• Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.

• Make sure that the medicines you have at home have not reached the ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

• Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge.

• Make sure that children cannot see or reach the medicine.

Who to contact for more information?

Your doctor, pharmacist or nurse will be able to give you more information about Tacrolimus ointment and about other medicines used to treat eczema.

Copyright disclaimer

Version [1]. © NPPG, RCPCH and WellChild, all rights reserved. Review by May 2027.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.