Overrated. I got approval from a top oral pathologist in the US to use protopic for 6+ months and he even recommended I continue it for longer. As I've posted before, protopic helped with inflammation initially however it caused my lips to become extremely sensitive to the sun and eventually I found that it was causing more irritation than I could handle. I keep in touch with this specialist who still recommends I use it from time to time, even though my current regimen (EpiCeram 3x daily) has been the most successful in fighting the inflammation and and somewhat managing buildup.
One thing about protopic worth noting is the peeling got a bit thinner after the fist few weeks of use, which is why i continued using it for about 7 months, thinking maybe it would get thinner and thinner, but it didnt. It may have just been a result of the tick petrolatum base rather then the tacrolimus.
FYI: here is the most recent email that the specialist kindly sent me:
"Overuse of petrolatum-based products is often more harmful than helpful, as noted in your message. The "standard" of treatment as far as the literature is concerned, remains Protopic, though the response is widely variable from one patient to another.
Recently a patient told me of a combined regimen of the drug doxepin (low dose) in conjunction with an anti-inflammatory / immunosuppressive drug (azathioprine), which I have no experience with, nor do I know of any published work that describes this approach, thus I can not recommend it. I do have a few patients recently that have received a "positive bump" with use of the low dose doxepin, though it seems unusual that an antianxiety / antidepressant drug would yield the results stated by some for this condition.
You may wish to check with your family doctor about a trial of doxepin, perhaps 25 mg at bedtime for a few weeks, while maintaining the Epiceram or Protopic with gentle once per day lip hygiene."