Clinical Question: Is tacrolimus ointment effective for the treatment of facial and intertriginous psoriasis?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: Investigators randomized 167 patients with facial or intertriginious nonplaque-type psoriasis in a double-blind fashion to receive 0.1 percent tacrolimus ointment or placebo applied twice daily to all areas of active disease. Outcomes were assessed by persons blinded to treatment group assignment. Complete outcome data were available for 86 percent of the original subjects at eight weeks of follow-up.

Using intention-to-treat analysis, patients receiving tacrolimus were significantly more likely to display clinical improvement of 90 percent or more than patients receiving the placebo ointment (66.7 versus 36.8 percent; number needed to treat = three). No significant differences were reported in the incidence of adverse events among the treatment groups. A second similarly designed study, published in the same issue, reported a statistically significant benefit to treating similar patients with 1 percent pimecrolimus cream (Gribetz C, et al. Pimecrolimus cream 1% in the treatment of intertriginous psoriasis: a double-blind, randomized study. J Am Acad Dermatol 2004;51:731–8)

Bottom Line: Tacrolimus ointment 0.1 percent and pimecrolimus cream 1 percent are effective in the treatment of facial and intertriginous psoriasis. Because this study reports results from only eight weeks of follow-up, information about long-term outcomes or potential complications is unavailable. (Level of Evidence: 1b–)