Severe Skin Peeling and Itching After Using Pimecrolimus Cream: Is It Normal?

After using Putty ointment, the skin experiences severe peeling and itching?

Hello, doctor.
I have symptoms of atopic dermatitis and seborrheic dermatitis, with a lot of dandruff and itching and peeling on my face, forehead, and behind my ears.
After seeing a doctor, I was prescribed an orange ointment called Protopic to apply on my face.
When I applied it, I felt that my face was very oily, and since my skin is already oily, it was uncomfortable.
However, I didn't notice any particular abnormalities at that moment.
But after 1 to 2 hours, the ointment dried on my face, and I began to experience intense itching and severe peeling.
Even a slight tug would cause large flakes of skin to come off, leaving my face red, itchy, and painful.
I would like to know if this is normal.
The doctor had warned me about potential side effects of burning and itching from the medication, but I didn't expect it to be this severe; it feels like my face is on fire.
Could this be due to applying too much medication, or could I be experiencing an allergic reaction to Protopic? Previously, another doctor prescribed a different ointment called Elidel, which caused stinging and tearing around my eyes when applied to my eyelids and the area around my eyes.
Should I ask my doctor to prescribe a traditional steroid ointment instead? I am really struggling with the side effects of the immunomodulatory ointment.

Jie, 20~29 year old female. Ask Date: 2022/11/17

Dr. Wu Yuxin reply Dermatology

This issue should be discussed with your clinical physician, as online consultations cannot resolve your problem.

Reply Date: 2022/11/17

More Info

Severe skin peeling and itching after using Pimecrolimus cream can be concerning, especially for individuals with atopic dermatitis or seborrheic dermatitis, as you described. Pimecrolimus is an immunomodulator that is often prescribed for inflammatory skin conditions, but it can have side effects that vary from person to person.

Firstly, it is important to understand that while Pimecrolimus is effective for many patients, it can cause local irritation, burning, and itching, particularly when first applied. The symptoms you are experiencing—intense itching, redness, and peeling—are not uncommon, especially if the cream is applied in excess or if the skin is particularly sensitive. The fact that you felt discomfort immediately after application suggests that your skin may be reacting to the formulation itself or the active ingredient.

In your case, the severe peeling and discomfort could be due to several factors:
1. Overapplication: Applying too much cream can lead to a buildup on the skin, which may exacerbate irritation and lead to peeling. A thin layer is usually recommended.

2. Skin Sensitivity: If your skin is already compromised due to conditions like atopic dermatitis, it may be more reactive to topical treatments. This sensitivity can lead to increased irritation and peeling.

3. Allergic Reaction: While less common, it is possible to develop an allergic reaction to Pimecrolimus. Symptoms of an allergic reaction can include severe itching, redness, swelling, and peeling.

4. Environmental Factors: Changes in climate, such as moving to a colder and drier environment, can also exacerbate skin conditions and lead to increased dryness and irritation.

Given your symptoms, it is advisable to take the following steps:
- Discontinue Use: Stop using the Pimecrolimus cream until you can consult with your healthcare provider. Continuing to use it may worsen the irritation.

- Consult a Dermatologist: It is crucial to see a dermatologist who can assess your skin condition and determine whether the symptoms are due to the medication or an underlying issue. They may suggest alternative treatments, such as traditional topical steroids, which can be effective for managing inflammation and irritation.

- Moisturize: In the meantime, focus on keeping your skin moisturized with a gentle, fragrance-free moisturizer. This can help soothe the skin and reduce peeling.

- Patch Testing: If you suspect an allergy, your dermatologist may recommend patch testing to identify specific allergens.

- Avoid Irritants: Be cautious with other skincare products, as they may contain irritants that can worsen your condition. Stick to gentle, hypoallergenic products until your skin has healed.

In conclusion, while some degree of irritation can be expected with Pimecrolimus, the severity of your symptoms suggests that it may not be the right treatment for you at this time. Consulting with a healthcare professional is essential to find a suitable alternative and to ensure that your skin condition is managed effectively.

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