Tacrolimus ointment: summarizing two decades of experience in off-label use. Use in rosacea, seborrheic dermatitis, papulosquamous dermatoses, lupus erythematosus, eczematous dermatoses, alopecia, and other diseases

Tacrolimus ointment, which belongs to the class of topical calcineurin inhibitors, is one of the most studied topical preparations in the history of dermatology. It has a pronounced immunosuppressive and anti-inflammatory effect by suppressing the activation of the T-cell immune response. The high selectivity of its mechanism of action, the absence of an atrophogenic effect, and the possibility of use on delicate areas of the skin have ensured sustained interest in the drug among both researchers and clinicians. Although the approved indication is limited to atopic dermatitis, in actual practice, considerable experience has been gained in the off-label use of tacrolimus ointment for a wide range of chronic inflammatory and autoimmune dermatoses. The first part of the review, published earlier, presented information on the history of development and pharmacological characteristics of the drug, as well as summarized data on its efficacy in vitiligo and fibrotic connective tissue diseases. This publication continues to systematize the available evidence base and focuses on analyzing the clinical experience of using tacrolimus in other nosologies. This part of the review examines the results of using tacrolimus ointment for rosacea, perioral and seborrheic dermatitis, papulosquamous dermatoses (including psoriasis and lichen planus), as well as for skin manifestations of lupus erythematosus. In addition, data are presented on the use of tacrolimus in various forms of eczematous dermatoses not associated with atopy, as well as in alopecia and a number of other less common skin diseases. Analysis of published clinical trials and observational series indicates the promise of expanding the range of indications for the use of the drug. Systematization of the presented data may contribute to a more informed and rational use of tacrolimus ointment in dermatological practice and sets directions for future research.