Long story short, I don’t know what the “correct” process is to treat Jimmy’s eczema. I spent so many months in his early life researching treatments, trying to find the perfect one.
We started the Dr. Aron Regime in November 2020. I was so stressed about using steroids on Jimmy I had a full blown anxiety attack. I’ve recently taken some of the pressure off myself, (my mental health was on a downward spiral) and I’m trusting our team at Boston Children’s Hospital. Recently Jimmy's allergist brought up the use of a topical calcineurin inhibitor or TCI. If you or a loved one is struggling with AD, hopefully you’ve looked into possibly using TCIs or have at least heard of using them. As always, I’m here to chat with, just send me a message and I’ll answer any questions you may have or just be a listening ear if that's what you need!
This photo of Jimmy is about 2 weeks before starting the Dr. Aron Regime.
Below is a compilation of information regarding Topical Calcineurin Inhibitors (TCIs), something I had never heard of until Jimmy’s allergist recommended we try it.
Since November 2020, we have been using a combination of steroid cream, antibiotic ointment, and moisturizing cream mixed together in a compound to manage Jimmy’s eczema. This particular treatment was prescribed to Jimmy by a doctor in Texas, Dr. John Van Wagoner, who uses a method called the Dr. Aron Regime. We started this treatment in November of 2020 with four applications of the compound daily. Now in April 2021, we are down to two applications daily with the goal of completely weaning off daily applications and just using the compound for maintenance. Before starting we understood that steroids weren’t intended to be used for extended periods of time. While we have been making huge strides with weaning off the steroid, Jimmy’s allergist wants to try and speed up the weaning process with a TCI.
What are TCIs, you ask? I was wondering the same thing. The National Eczema Association has an informative article that gives a great overview. You can find the full write up here.
Topical calcineurin inhibitors (TCIs) are nonsteroidal medications that work by stopping certain cells of the immune system from “switching on,” preventing eczema symptoms such as redness and itch and inflammation. Two TCIs are available for use in eczema, tacrolimus ointment and pimecrolimus cream.
TCIs can be applied to all affected areas of the skin, including areas of delicate or thinner skin such as the face, eyelids, genitals, or skin folds, where the short- or long-term use of topical steroids may not be preferred. TCIs can be used for extended periods of time to control symptoms and reduce flares. Common side effects with TCIs include mild burning or stinging sensation when the medication is first applied to the skin.
In 2006, the FDA implemented a black box warning for TCIs regarding long-term safety and a possible risk of lymphoma (a type of blood cancer). To date, a causal link between TCIs use in eczema and these cancers has not been shown.
I also found an interesting study about TCIs and Atopic Dermatitis (AD) on the NCBI website. The whole article summarizes the mechanism of action of TCIs, the factors that prompted the Boxed Warning, and recent TCI safety and efficacy data. You can find the whole article here.
I hope this information is helpful to you! I’m always learning so if you have some more information that you’d love to share, please send it my way!
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