Low But Detectable Serum Levels of Tacrolimus Seen With the Use of Very Dilute, Extemporaneously Compounded Formulations of Tacrolimus Ointment in the Treatment of Patients With Netherton Syndrome

Management of congenital ichthyoses: European guidelines of care, part two

“…Topical tacrolimus ointment (0·03% or 0·1%) and pimecrolimus cream (1%) (available only in some European countries) have been used in a limited number of patients with NS: one prospective series of three patients, four retrospective series of two to four patients and four case reports . All but one patient reported efficacy.…”

Toxic serum levels of tacrolimus after topical administration in an infant with severe cutaneous graft-versus-host disease

“…[4][5][6][7] Even after extemporaneously compounding 0.005 and 0.01%, significant cutaneous absorption was observed in three children with Netherton syndrome. 8 Our case is the first case report on toxic levels of tacrolimus after topical administration in a child who underwent an unrelated umbilical cord blood HSCT and presented a severe cutaneous GVHD. The levels of tacrolimus of this patient were stable before the introduction of the topical form and then became toxic.…”

Topical treatment of ichthyoses

“…However, all of the patients so treated were found to have significant blood levels of tacrolimus that were either within or above the reference trough levels typically associated with use of oral tacrolimus in organ transplant patients . Even when topical tacrolimus was extemporaneously compounded in more dilute formulations (0.0075, 0.01, and 0.03%), the use of these agents was still associated with significant systemic absorption . There have been reports of some NS patients, however, who have had either undetectable or very low tacrolimus blood levels when treated with topical tacrolimus 0.03 or 0.1% ointment .…”