Images in Clinical Medicine

Tacrolimus Ointment, Alcohol, and Facial Flushing

Jann Lübbe, M.D., and Maria Milingou, M.D.

N Engl J Med 2004; 351:2740December 23, 2004

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Article

A 56-year-old patient was treated with 0.1 percent tacrolimus ointment because of rosacea that had been aggravated by prolonged use of topical corticosteroids. After two weeks of treatment, she had an unprecedented episode of facial flushing during an evening reception where alcoholic beverages were served. The patient agreed to undergo a test to see whether the reaction could be reproduced in a clinical setting. After one week of twice-daily application of 0.5 g of 0.1 percent tacrolimus ointment on the face, she ingested 0.05 liter of white wine. The images show the patient before exposure to alcohol (Panel A) and 12 minutes after exposure (Panel B). The erythema faded after 45 minutes. One month after the discontinuation of treatment with tacrolimus, the patient's tolerance of alcohol was normal. Intolerance to alcohol occurs in up to 7 percent of adult patients who are treated with topical tacrolimus and has also been reported with pimecrolimus cream.

Jann Lübbe, M.D.
Maria Milingou, M.D.
Geneva University Hospital, 1211 Geneva 14, Switzerland

Citing Articles (5)

Citing Articles

1. 1

   C. de la Torre. (2008) Intolerancia al alcohol con rubor facial transitorio por tratamiento tópico con pimecrolimus. Actas Dermo-Sifiliográficas 99:5, 422-423
   CrossRef

2. 2

   Sibylle Schliemann, Daniela Kelterer, Andrea Bauer, Swen M. John, Christoph Skudlik, Ingo Schindera, Wolfgang Wehrmann, Peter Elsner. (2008) Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis. Contact Dermatitis 58:5, 299-306
   CrossRef

3. 3

   Graham R Jang, Robert Z Harris. (2007) Drug interactions involving ethanol and alcoholic beverages. Expert Opinion on Drug Metabolism & Toxicology 3:5, 719-731
   CrossRef

4. 4

   Susan T. Nedorost. (2007) Medical Pearl: The evaluation of perioral dermatitis: Use of an extended patch test series. Journal of the American Academy of Dermatology 56:5, S100-S102
   CrossRef

5. 5

   Adina K. Knight, Mitchell Boxer, Michael J. Chandler. (2005) Alcohol-induced rash caused by topical tacrolimus. Annals of Allergy, Asthma & Immunology 95:3, 291-292
   CrossRef