Clobetasol vs. Tacrolimus for Eczema: Important Differences and Potential Risks.

Key takeaways

Clobetasol (Clobex, Olux) and tacrolimus (Protopic) are both topical medications used to treat skin conditions, but they belong to different medication classes. Clobetasol is a corticosteroid used for conditions like psoriasis and eczema, while tacrolimus is an immunosuppressant specifically approved for moderate-to-severe eczema. Clobetasol is a super potent steroid available in various forms like cream, shampoo, and spray, and is typically used for up to 2 weeks (4 weeks for shampoo). Tacrolimus, on the other hand, is a non-steroid ointment available in two strengths and can be used for up to 6 weeks or longer under a prescriber's guidance. Clobetasol is available as a lower-cost generic and is not recommended for use on the face, armpits, or groin, whereas tacrolimus can be applied to these areas. Common side effects of clobetasol include burning and skin irritation, while tacrolimus may cause burning, itching, and flu-like symptoms. Clobetasol can lead to skin thinning and high blood sugar if used long-term, while tacrolimus carries a risk of skin infections and increased sensitivity to sunlight.

Clobetasol

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Tacrolimus

(Prograf)

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Summary for Clobetasol

Prescription only

Clobetasol is a super potent (very strong) corticosteroid that's applied to the skin. It helps relieve skin inflammation and irritation from moderate-to-severe skin problems, like psoriasis. Clobetasol is available in many different formulations. This includes a cream, ointment, shampoo, topical solution, and foam. Most formulations are for people 12 years and older. But others, like the shampoo and lotion, are for adults only. Some side effects include burning, stinging, and irritation where it's applied. Clobetasol has both brand-name and generic options.

Indications for Clobetasol

Skin rashes and itchy skin - all topical forms except shampoo
Plaque psoriasis not on the scalp - all topical forms except shampoo
Moderate-to-severe scalp psoriasis - shampoo and certain foams only

Pros and Cons for Clobetasol

Pros

One of the most potent (strongest) topical steroids
Applied directly to the affected area(s) of skin
Many formulations to choose from, such as ointment, cream, and spray
Works well for managing psoriasis symptoms

Cons

For short-term use only (usually no more than 2 weeks at a time) to prevent skin thinning and other problems
Not safe to use on the face, armpits, or groin
Some formulations are only for adults (e.g., shampoo, lotion, spray)
Not known if safe to use while pregnant or breastfeeding

Common Side Effects for Clobetasol

Burning
Stinging
Skin irritation
Itching

Warnings for Clobetasol

More skin reactions with longer use and coverings
Changes in stress hormone levels
Topical steroid withdrawal
Higher risk of cataracts and glaucoma
Treat any skin infections appropriately
Flammable (clobetasol foam, solution, and spray only)

Summary for Tacrolimus

Prescription only

Tacrolimus (Prograf) is a medication used to prevent organ rejection after an organ transplant. The immediate-release (IR) capsules are available as a lower-cost generic medication, whereas the IR granules (Prograf) and extended-release (ER) capsules (Astagraf XL) are only available as brand-name medications. Tacrolimus (Prograf) is taken by mouth, typically twice daily. Your provider will check your tacrolimus level through blood work and adjust your dose if needed. Common side effects of tacrolimus (Prograf) include tremors, headache, diarrhea, and nausea.

Indications for Tacrolimus

Prevention of organ transplant rejection, including:

Kidney transplant
Liver or heart transplant - generic tacrolimus capsule and brand name Prograf only
Lung transplant - brand name Prograf only

Pros and Cons for Tacrolimus

Pros

Available in short-acting and long-acting forms, so there's an option to take once or twice daily
Available as granules to mix into a solution (Prograf), so it's convenient for people who have trouble swallowing
Can be used to prevent organ rejection after different types of transplant
Less likely to cause high cholesterol levels compared to other transplant medications

Cons

Interacts with many medications, such as phenytoin (Dilantin) and omeprazole (Prilosec)
Need to get regular blood work to check for appropriate dose and side effects
Risk of serious infections
Can cause side effects such as tremor, headache, and diarrhea

Common Side Effects for Tacrolimus

Tremor (54%)
High blood pressure (50%)
Changes in electrolyte levels (up to 49%)
Infections (up to 45%)
Higher creatinine levels (45%)
Headache (44%)
Diarrhea (44%)
Nausea (38%)
Swelling of hands and feet (36%)
Constipation (35%)
Feeling weak (34%)
General pain (up to 33%)
Trouble sleeping (32%)
Low red blood cell count (30%)

Warnings for Tacrolimus

Possible risk of skin or lymph node cancer
Serious infections
Higher risk of death in females taking Astagraf XL after liver transplant (not an FDA-approved use)
High blood sugar
Kidney problems
Nerve or brain problems
High blood pressure
Heart problems
Blood problems
Harm to unborn babies and lower sperm count
Interaction with vaccines
Interaction with other medications