Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Periorbital erythema following alcohol ingestion during treatment with topical tacrolimus

Kathryn Woolner and Maxwell Sauder
CMAJ March 15, 2016 188 (5) 368; DOI: https://doi.org/10.1503/cmaj.150710
Kathryn Woolner
Faculty of Medicine (Woolner); Division of Dermatology, Department of Medicine (Sauder), University of Ottawa, Ottawa, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maxwell Sauder
Faculty of Medicine (Woolner); Division of Dermatology, Department of Medicine (Sauder), University of Ottawa, Ottawa, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: maxwell.sauder@medportal.ca
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

A 32-year-old man, who was undergoing treatment for eyelid dermatitis with topical tacrolimus ointment 0.1% (0.5 g applied twice daily for 1 wk), presented with periorbital erythema accompanied by a mild burning sensation that developed 30 minutes after he ingested one alcoholic beverage (Figure 1). The eruption was limited to the application site and resolved within one to two hours.

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

Well-demarcated periorbital erythema that appeared under both eyes after ingestion of one alcoholic beverage in a 32-year-old man undergoing treatment for eyelid dermatitis with tacrolimus ointment 0.1%.

Tacrolimus ointment is a topical calcineurin inhibitor approved for the second-line treatment of atopic dermatitis in adults (0.03% and 0.1%)and children over two years of age (0.03%), and for maintenance therapy to prevent flares.1 Use of topical corticosteroids can result in thinning of the skin; topical tacrolimus is advantageous because it does not induce atrophy2 and is commonly used to treat eyelids and intertriginous areas. There is also evidence for the off-label use of tacrolimus for other causes of dermatitis, psoriasis, vitiligo and lichen planus.3

With tacrolimus use, the most common adverse events that occur at the application site are a burning sensation, pruritus and erythema (usually short-lived, minutes to hours); patients typically develop tolerance within the first few days of consecutive use.4 Anecdotally, refrigerating the ointment and applying it cold may overcome the burning sensation.

In two randomized double-blind multicentre studies involving 631 adult patients with moderate to severe atopic dermatitis treated with topical tacrolimus, the arm treated with 0.1% ointment (209 patients) reported a 6.9% incidence of alcohol intolerance (skin flushing, redness and burning sensation).4 This interaction has been reported extensively but may not be widely recognized in clinical practice.

This case serves as a reminder of the importance of counselling patients about the expected brief burning sensation that resolves with consecutive use of topical tacrolimus and the interaction with alcohol ingestion. We suggest that patients be advised that these adverse events are not dangerous and will resolve within hours. Alternatively, patients may choose to abstain from alcohol ingestion during treatment.

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • The authors have obtained patient consent.

References

  1. ↵
    Product monograph: Protopic® tacrolimus ointment 0.03% and 0.1% (w/w) topical calcineurin inhibitor. Markham (ON): Astellas Pharma Canada, Inc.; 2010. Available: www.astellas.ca/pdf/en/monograph/2010-09-24ProtopicProductMonograph-En.pdf (accessed 2015 June 5).
  2. ↵
    1. Kyllönen H,
    2. Remitz A,
    3. Mandelin JM,
    4. et al
    . Effects of 1-year intermittent treatment with topical tacrolimus monotherapy on skin collagen synthesis in patients with atopic dermatitis. Br J Dermatol 2004;150:1174–81.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Lin AN
    . Innovative use of topical calcineurin inhibitors. Dermatol Clin 2010;28:535–45.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Soter NA,
    2. Fleischer AB Jr.,
    3. Webster GF,
    4. et al.
    Tacrolimus Ointment Study Group. Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part II, safety. J Am Acad Dermatol 2001;44:S39–46.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (5)
CMAJ
Vol. 188, Issue 5
15 Mar 2016
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Periorbital erythema following alcohol ingestion during treatment with topical tacrolimus
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Periorbital erythema following alcohol ingestion during treatment with topical tacrolimus
Kathryn Woolner, Maxwell Sauder
CMAJ Mar 2016, 188 (5) 368; DOI: 10.1503/cmaj.150710

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Periorbital erythema following alcohol ingestion during treatment with topical tacrolimus
Kathryn Woolner, Maxwell Sauder
CMAJ Mar 2016, 188 (5) 368; DOI: 10.1503/cmaj.150710
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Infected atrial myxoma presenting with purpura
  • Mild bleeding disorders in adults
  • Cerebral venous and sinus thrombosis with complicating thromboangiitis obliterans
Show more Practice

Similar Articles

Collections

  • Sections
    • Clinical Images
  • Topics
    • Family medicine, general practice, primary care
    • Drugs: adverse reactions
    • Dermatology

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire