lemma health

*Warning: Gross ‘before’ pics* I am in absolute utter shock by how good tacrolimus is. I have been suffering with eczema for as long as I can remember but I just recently got the WORST case of it. Never in my life has my eczema been this severe. I have no idea what caused it, though my guess is that it was very much heightened by the sudden onset of intense stress that came from starting my new job. Anyway, at first it started off pretty tame, but it quickly got very angry. Any other time, I would typically ignore my eczema as it usually goes away on its own within a few days, but this time it was not going away and it became very noticeable. (pic: https://imgur.com/a/duAn0XI ) It was painful, it was ugly, I felt gross and icky all the time, I was either soaking blood through my sheets from clawing my skin off or I was shedding dry skin like no tomorrow. I bought COUNTLESS over the counter products and scoured this subreddit for anything that could possibly help me before I finally relented and scheduled a doctor’s appointment a whole state away because I couldn’t get one fast enough. Took the day off work without telling anyone, I was so fed up. The doctor took a look at me a good 5 minutes and sent me home with Tacrolimus 0.1%. That night, I went back and slathered it all over my neck. I didn’t research into this at all before applying, and had the worst experience ever that night. I feel like most people that have used this product knows it BURNS AND ITCHES the first few times, and boy how it did. I could not sleep at all that night and felt like I was going crazy. I ended up quitting it that night because I could not take the burning & itching. The next week, my neck got even worse. I reached my breaking point this past weekend upon waking up with a neck looking like this (https://imgur.com/a/Jsc0eka). I was so freaked out, I felt like I had no other choice but to try that stupid ointment again so that’s what I did. I put maybe a little too much on out of sheer anger and frustration and suffered through the pain. I cannot emphasize this enough, it HURT and BURNT like a mothertrucker. I had to take 4 advil to calm myself down and slept the whole day to avoid the pain. But the pain subsided a little every time I applied it. I used this ointment twice a day everyday for the last FOUR DAYS. You can count that with ONE HAND. My neck looks like this tonight (pic: https://imgur.com/a/CMuicnL) and I am floored. It was worth the pain because now my neck is the softest its been in a WHILE and I feel no pain. I love Tacrolimus so much. The end. Thanks for coming to my Ted Talk.

I've been dealing with severe eczema for a little over a year. My first dermatologist (a very large NoVA practice) was apparently stumped by the notion of *adult-onset* eczema, leading to a bunch of wasted time and money on misguided diagnoses and ineffective treatments. (Takeaway message: Large medical practices maximize profit and volume by following a narrowly defined script. And if your condition doesn't fit the script, they can't help you.) My new dermatologist rapidly got me on a biweekly Dupixent regimen that has knocked down most of my symptoms to about 10% of severity. I plan to talk to them about ramping up to a weekly regimen (my eczema starts to return during the last 3-4 days of the two-week cycle), but even the current regimen has basically given me my life back... ...except for my face. My eyelids constantly look red, raw, crepey, flaky, or some combination. They are constantly itchy, stinging, and/or watering. I've developed deep creases below my eyes that make me look tired and/or 20 years older. It has been brutal and has not responded to every imaginable combination of creams and ointments in my bag: Aquaphor, CeraVE, Eucerin, Desonate, Muciropin, etc., etc. I've noticed the positive buzz here about Protopic. After a brief discussion, my dermatologist called the prescription in to a specialty pharmacy, and I received my first tube of Protopic today, with these instructions: > Apply to affected areas on face and body twice a day for two weeks then stop and take one week off. Can repeat as needed when flaring. Within 10 minutes of applying the ointment, I started feeling some heat. 10 minutes later, my face was *on fire.* It's been about 30 minutes and the temperature is starting to recede, but... wow. Quite the rush. While coping with the heat, I did some searching and found [this interesting article from a dermatology medical journal](https://www.medicaljournals.se/acta/content/html/10.2340/00015555-2699#:~:text=The%20burning%20sensation%20after%20application,in%20adults%20than%20in%20children.), and found the bolded parts especially informative: > Atopic dermatitis (AD) is strongly associated with skin barrier dysfunction, as indicated by a reduction in skin hydration and an increase in transepidermal water loss (TEWL). Long-term use of topical corticosteroids poses a risk of developing adverse cutaneous effects, including skin atrophy and rebound flares. Topical calcineurin inhibitors, tacrolimus and pimecrolimus, were found to be as effective as moderately potent topical corticosteroids. However, the main obstacle to use of topical tacrolimus is its local side-effect, a burning sensation, which sometimes leads to discontinuation of treatment. Although the mechanism of the burning sensation after topical application of tacrolimus is thought to be associated with damaged skin barrier function, there has been no study to assess the association between TEWL and burning sensation following topical application of tacrolimus. This study evaluated the correlation between burning sensation following topical tacrolimus and skin barrier function in AD. > DISCUSSION > In this study TEWL was statistically significantly higher in patients with a burning sensation after the application of tacrolimus ointment than in those without a burning sensation. Elevated TEWL can predict burning sensation after the application of tacrolimus ointment. > The main advantage of topical tacrolimus is the provision of proactive therapy. More recently, Chittock et al. showed that proactive use of topical tacrolimus promotes reparation of the subclinical barrier defect in AD. Topical tacrolimus does not cause skin atrophy and can be used safely on the more vulnerable regions of the skin, such as the face and neck. Long-term safety of topical tacrolimus has been confirmed.** > However, the adverse effects of topical tacrolimus are transient application-site reactions, such as burning or pruritus. These side-effects lead to treatment discontinuation in 1.6–5.3% of patients with AD. In the present study, 21.7% of patients discontinued the use of tacrolimus ointment due to the burning sensation. Approximately 16–59% of patients experienced a burning sensation and approximately 9–46% of patients reported pruritus in other clinical studies (3, 8). The burning sensation after application of tacrolimus ointment lasts for approximately 15–20 min, for the first few days of treatment. In general, the burning sensation, pruritus and erythema resolve within one week of initiating topical tacrolimus and occur more frequently in adults than in children. **These complications are related to disease severity. Such events decrease rapidly as AD lesions heal with improving skin barrier and skin hydration.** In short, the burning is both an indicator of eczema severity and a sign that the medication is working. And a temporary feeling of heat is nothing compared to my deep-seated burning hatred of eczema and the time that I've

Honestly, what a drug. Been dealing with the worst flare of my life for the past few months. Affected my face, which never used to happen. I felt so uncomfortable and didn’t feel able to participate in social activities. My work suffered too. A couple of applications of protopic (only 0.03!) and I finally have some relief. I should note that that wasn’t the only thing I used. It seems I was dealing with an infection and the dermatologist put me on antibiotics. Since starting these my overall condition in other affected areas is improving. While it didn’t present in what I’d consider the typical signs of infection, it looks like that was what was exacerbating things. Protopic however, has been the most crucial in dealing with the superficial aspects. But yeah, push your derm to prescribe you protopic instead of steroids if you’re suffering from facial eczema, absolute life changer.