Tacrolimus ointment for the treatment of steroid-induced rosacea: A preliminary report

Background: Excessive topical corticosteroid application to facial areas commonly leads to steroid-induced rosacea. This may be a recalcitrant problem that requires months of antibiotic and antiinflammatory therapy before it resolves. Objective: The purpose of this article is to review the use of tacrolimus ointment, a macrolide antiinflammatory ointment for the treatment of 3 patients with steroid-induced rosacea. Methods: Three patients with steroid-induced rosacea applied tacrolimus ointment, 0.075% twice daily for 7 to 10 days. Patients were also instructed to avoid topical corticosteroid use and other rosacea-aggravating substances including caffeine, spicy foods, alcohol, hot fluids, and fluoride. Patients were observed for tenderness, erythema, and relief of pruritus. Results: Pruritus, tenderness, and erythema were resolved in all 3 patients after 7 to 10 consecutive days' use of tacrolimus 0.075% ointment in conjunction with a-voidance of topical steroids, caffeine, spicy food, alcohol, hot fluids, and fluoride. Conclusion: This preliminary study demonstrates that tacrolimus 0.075% ointment may be effective for patients with steroid-induced rosacea, when combined with avoidance of topical steroid use, as well as avoidance of other agents known to aggravate rosacea (caffeine, spicy foods, alcohol, hot fluids, and fluoride).