The use of 1% pimecrolimus cream for the treatment of steroid-induced rosacea

Conflicts of Interest: none declared. Sir, Steroid‐induced rosacea is characterized by a rosacea‐like dermatitis that develops in the facial area (particularly the centrofacial, perioral and periocular areas) of patients who have been treated for long periods with topical steroids (particularly fluorinated steroids).1, 2 Traditionally, the treatment of choice for this condition has been the avoidance of the application of topical steroids to the face and the use of topical antibiotics, tetracycline antibiotics and/or antihistamines.2 Even when such a regimen is followed, steroid‐induced rosacea may remain a recalcitrant problem because withdrawal of topical steroids may lead to a rebound of the previous steroid‐responsive facial dermatosis. Pimecrolimus 1% cream, a topical calcineurin antagonist, can inhibit T‐cell activation by blocking the action of calcineurin, resulting in the downregulation of interleukin (IL)‐2, IL‐4, IL‐10 and other cytokines.3, 4 It has been shown to be a safe and effective therapeutic alternative to topical corticosteroids for the treatment of atopic dermatitis in children and adults.3, 4 Another topical calcineurin antagonist, tacrolimus ointment, is increasingly used for the treatment of inflammatory dermatoses in sensitive areas such as the face and mucosal areas.5, 6 Recent reports demonstrate successful management of steroid‐induced rosacea and perioral dermatitis with tacrolimus ointment.7, 8 These observations indicate that pimecrolimus cream might be useful for treating steroid‐induced rosacea. This report describes two patients with steroid‐induced rosacea that responded to therapy with topical pimecrolimus.