Here's a dilemma: You need to treat psoriasis on an area where strong topical steroids may be a problem, but milder corticosteroids are ineffective. What do you do? One easy solution is to use a non-steroid topical medication. However, many of these, like Dovonex or Psoriatec are typically too irritating to use on sensitive facial or groin skin. For a solution, we have to look outside the list of FDA-approved psoriasis drugs and utilize some drugs used and approved for eczema. Using an approved drug for an unapproved use is called "off-label" use and it's not only perfectly legal, its actually quite common in dermatology practice. The drugs I'm referring to are Protopic (tacrolimus) and Elidel (pimecrolimus).
Protopic is an ointment which can be useful for psoriasis of the face and groin. One unusual side effect of Protopic is that areas treated become red upon ingestion of alcohol -- something which patients may have brought to their attention at a dinner party if they are not warned of this beforehand. Elidel works like Protopic, but its cream base is less greasy and perhaps a bit more comfortable (although it may not be quite as effective for this condition). Both drugs are excellent for inverse psoriasis of the skin folds. They also both may cause a bit of mild stinging with initial use. Several years after their release, both drugs received a "black box" warning regarding risks of infection or malignancy. The American Academy of Dermatology and others have gone on record with the position that the drugs are indeed safe when used appropriately.
Whether or not off-label use of these drugs is right for you is a decision you and your dermatologist have to make together. At times, insurance companies are reluctant to cover the use of these relatively expensive drugs when cheaper steroids are available. However, a letter from your dermatologist indicating the specific need for a non-steroid drug in a given circumstance may get the drug approved.
