How I'm Using Protopic / Tacrolimus While on Dupixent and Avoiding Withdrawals

I made a decision last month to use Tacrolimus (generic version of Protopic ointment) while on Dupixent (a biologic eczema medication). Not one time, but in an ongoing manner. It was not an easy decision to make - considering the many fellow eczema fighters that have ended up in withdrawal from Tacrolimus.

What is Tacrolimus Withdrawal?

The eczema community says it’s just like Topical Steroid Withdrawal (TSW), which I went through during my first pregnancy. It’s what can happen when you overuse the Tacrolimus ointment on your body to combat flareups. The ointment stops working (or you may suddenly stop using it after overusing it) and then withdrawal symptoms take over. It’s a new world beyond eczema, with burning, redness, fierce itching, flaking, swelling, oozing, and crustiness. It has its own timeline - I was lucky to have TSW for only a year. Many folks suffer years in withdrawal. It’s a debilitating, life altering struggle and I wouldn’t wish it on my worst enemy (not that I have any).

Why I Chose To Use Tacrolimus?

Ironically, Protopic / Tacrolimus (along with Dupixent) helped save me towards the end of my topical steroid withdrawal in 2017. I stopped Dupixent in 2018 to get pregnant for my second child. I continued using Protopic until late 2022. Well, 2023 was not good. I tried for a solid year to avoid my allergens and triggers, but the bubble I must live in doesn’t exist.

I decided to restart Dupixent in late 2023 and, to my surprise, I was flaring up from the Dupixent itself - apparently, it often causes fungal infections and flareups around the mouth and neck. My new derm immediately recommended I use Protopic / Tacrolimus. I said “absolutely not!” But I started reconsidering a few weeks later and decided to restart Tacrolimus while on Dupixent. I needed to be safe about it, though, and needed to trust my derm that they could help protect me from withdrawal symptoms.

How I’m Avoiding Protopic Withdrawal

I’ve got serious trust issues when it comes to dermatologists and tend to believe that most of the medical industry is pretty unaware of withdrawal consequences from the use of eczema ointments. I had a new derm and needed to feel confident that they understood not only about withdrawals, but also how to avoid it. After building trust with my derm, we discussed my treatment plan: use Protopic as sparingly as possible, but also as needed. And we’ll monitor if it becomes less effective, because that would be a big red flag.

Because I’m on Dupixent, my flareups are more contained and occur less often. So, I won’t need Protopic as often as I did pre-Dupixent. But Dupixent causes flareups soon after my injection - and it also doesn’t contain my eczema 100%. I’m fine to use Protopic sparingly to combat my mild to moderate flareups, whenever I do have them.

Specifically, my derm advised me to use Protopic / Tacrolimus once or twice a day on the affected areas, for a few days every two weeks, which is how often I have my injection and about how often I get flareups nowadays. This treatment plan works perfectly for me now.

How Will I Know if I’m At Risk for Tacrolimus Withdrawal?

According to my derm, we will monitor how my skin is reacting to the protopic / tacrolimus. If the ointment starts to be less effective, it’s a sign that my body is headed towards Tacrolimus withdrawal. The key is to identify this sign early on and not once I’m deep in withdrawal, which is how I ended up with TSW. Fingers crossed that I never see this sign, but if I do, I’ll work with my derm for a safe way to taper off Tacrolimus or switch to something else. What I won’t do is what I did last time: be blind to the possibility of withdrawals and lather my body with topical steroids until I wake up one day and look at my deeply wounded body wondering if it’s being attacked by eczema or something else.

How I am Doing while on Tacrolimus and Dupixent

I’m doing great! I feel so much better than last month, when I was dealing with breakouts while on Dupixent. And I feel way better than 5 months ago when I restarted Dupixent and had little control over my flareups.

My flareups still happen, but they’re contained. As I sit writing this, I’ve got a small flareup on my neck (still from that jacket I wore last week - thanks dust mite allergy!) and on my arm (same spot I’ve had for years, just not as bad) and a little around my mouth (probably from my Dupixent injection a few days ago). I’ll use Protopic on my flareups today and will be grateful that there’s a treatment that I’m confident will work, and that I’m monitoring for safe use.

And, as I often feel when my skin is healthyish, I feel beautiful again!




Why I Got Back on Dupixent 5 Years Later

Why I Started Dupixent 5 Years Ago

I've had eczema for decades now, from mild to moderate to severe. During my first pregnancy it became insufferable, because I went through Topical Steroid Withdrawal (TSW). I wouldn't wish TSW on my worst enemy (not that I have them!). I'm grateful that my TSW improved after my pregnancy, but my system was still out of whack. At the time, Dupixent had just been approved by the FDA and I was lucky to be able to access the medication. I got on Dupixent on May 2017 and it quickly helped, ultimately clearing me completely.

Why I Stopped Dupixent After Nearly 1 Year

But then I wanted to get pregnant again. At the time, no human testing had been done to determine if it was safe to be on Dupixent while pregnant. My allergist determined, through animal testing reports, that I shouldn't be on it and we figured out how many months prior to getting pregnant I should be off Dupixent. So, I got off Dupixent on February 2018, 9 months after starting it, to get pregnant again. And, yes, I was pretty scared about what would happen. Would I go through TSW again? Would my eczema come back with a vengeance?

5 Years Post Dupixent

For awhile, I was mostly fine after getting off Dupixent. I was ecstatic. I'd still get flareups, but they weren't too bad - I was mild to moderate for a few years, which I found acceptable. I told myself I would only get back on Dupixent if my eczema became moderate to severe consistently.

Well, my eczema has been progressively getting worse these last few years. My flareups started lasting longer and became more severe. I thought I could treat it by getting off all medications and just avoiding my allergens. I got off Protopic (i.e., Tacrolimus) … finally. I got yet another allergy patch test and discovered new serious skin allergies. I became obsessed with avoiding my allergens, and it seemed to be working for some time.

But I lost control. Or maybe I never actually had control. My flareups were getting really bad, spreading and lasting months. In fact, they were never fully going away, just spreading and receding, like a tide. An eczema tide. And they ranged from being an angry flareup to a moderate flareup and, if lucky, to a mild flareup. Like a burning light inside me that got brighter or less bright, but always lit. An eczema light burning inside me. Tide … light … whichever eczema analogy I use doesn't matter - it was terrible and I needed help.

I Lost Hope with my Skin Allergies

I moved to Austin almost 2 years ago and hadn't gotten a new allergist or dermatologist yet. So I went on the hunt for an allergist. I saw two allergists and both gave me conflicting info (0f course!), but both said one thing in common: I was severely under-treated.

I considered going back on allergy shots, something I've tried twice before but gave up on both times, because I never saw results. Maybe I had given up too soon both times. The second Austin allergist, Dr. John Villacis, (whom I've chosen as my ongoing allergist), however, explained that allergy shots only work about 50% of the time. And they should start helping within 6 months. Since I've tried them before (and at least for 6 months each time), we decided the problem wasn't that I had given up on them before, but that I was probably in the group of the 50% that doesn’t get help from allergy injections. My system would always overreact. Both allergists highly recommended Dupixent - I had already tried it before and it significantly helped me last time. Plus, it has helped so many people since I first tried it back in 2017.

Deciding to Start Dupixent Again

My eczema is closely related to my many and ridiculous skin allergies. I've decided that the bubble my body needs to live in to avoid these allergens does not exist. Benadryl is the only thing slightly helping at this point, but I can’t be on Benadryl 24/7 and live my life asleep or groggy constantly. It is time to get back on Dupixent. I feel hope again.


Double Benadryl Night

It’s a double Benadryl night

It’s been awhile, thought I could cope

But this year has been rough

And this flareup won’t stop

No lotions or ointments;

They don’t work anyway

I’m to avoid my triggers, ha.

I’ve said it before and I’ll say it again,

The bubble I must live in

Doesn’t exist.

Maybe it’s time to do real meds again.

For tonight, it’s two Benadryl.

Tomorrow is another day

(And I’m sure I’ll be drowsy.)

ChatGPT Poem About Eczema

I asked ChatGPT to write a poem about eczema and it did not disappoint:

Eczema, oh how you itch and you burn
A constant reminder, my skin takes its turn
Red and inflamed, it never seems to rest
A daily battle, one I cannot best

Dry and scaly, a constant state
My skin's own war, one I cannot escape
Creams and ointments, a daily routine
But still the itch, the urge is so keen

A constant companion, always there
Eczema, my burden, my cross to bear
But I will not let it defeat me
I will fight, with all my energy

For though my skin may be flawed
I am more than a rash, more than a scab
Eczema may mark me, but it does not define
I am strong, I am bold, I am one of a kind

So I'll keep on fighting, with all of my might
Eczema, you may mark my skin,
but you will not win this fight.

Affirmations for Taking a Shower with Intense Eczema Flareups

  1. I can do this.

  2. It’ll be fast - just in and out.

  3. Flared-up skin needs cleaning also.

  4. I can control the water temperature.

  5. Close my eyes and think about something else during the shower.

  6. Cleaning flareups is important to avoid skin infections, which makes it worse.

  7. Do it now so I don’t have to think about doing it the rest of the day.

  8. Go now!

Okay, no more pacing in the bathroom while the water runs. I’m going in!

Merry, merry, itch, itch

’Twas the night before Christmas and all through the night,
not a creature was stirring, not even a mouse.

Wait, what’s that?
It’s me scratching
my itch, itch, itch.
On my forehead, that’s new.
near my hairline, how odd.

Ah, I remember!
An elf costume I wore
for my two little kiddos.
A hat on my head for just one hour
Ho, ho, ho
Itch, itch, itch

Dust mite allergies are relentless,
the worst Christmas grinch.
But an itch is okay
it’s family and cheer that matter.

Merry Christmas to all, and to all a good night!