title: Dosage and adverse effects of topical tacrolimus and steroids in daily management of atopic dermatitis.
abstract: Since 1999, combination therapy with tacrolimus and topical steroids has been widely used for the treatment of adolescent/adult-type atopic dermatitis. In order to determine the clinical doses of topical tacrolimus and steroids for daily treatment of atopic dermatitis and to elucidate their beneficial and adverse effects, we analyzed the clinical data from 215 patients with atopic dermatitis who were more than 16 years old. Less than 70 g of tacrolimus and less than 15 g of steroids were applied to 90% of the patients on the face and neck, and less than 75.8 g of tacrolimus and less than 322 g of steroids were applied to 90% of the patients on the trunk and extremities during the six-month treatment period. Topical tacrolimus is much more frequently used on face and neck lesions (99.1%); in only 39.5% of cases was it used on the trunk and extremities. The majority of patients improved after six months of the combination topical therapy; however, atopic dermatitis was not controlled in 6% of the patients. The combination therapy did not seem to increase the risk of cutaneous infections; however, the incidence of herpes simplex infection on the face and neck was 2.8% at pre-treatment and slightly increased to 4.7% during the therapy. The incidence of all steroid-induced adverse effects was reduced both in frequency and intensity with a decrease in the dose of topical steroids through simultaneous tacrolimus application. Combination therapy with topical tacrolimus and steroids is useful for treating atopic dermatitis, but a small percentage of the patients still cannot be satisfactorily treated. For such patients, adjustments of the dose and rank of topical steroids and tacrolimus and other therapeutic adjuncts are necessary.
authors.affiliation: Department of Dermatology, Kyushu University, Fukuoka, Japan.
authors.forename: Masutaka
authors.initials: M
authors.lastname: Furue
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Terao
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Moroi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Koga
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kubota
authors.forename: Juichiro
authors.initials: J
authors.lastname: Nakayama
authors.forename: Fukumi
authors.initials: F
authors.lastname: Furukawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Ichiro
authors.initials: I
authors.lastname: Katayama
authors.forename: Naoko
authors.initials: N
authors.lastname: Kinukawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Nose
authors.forename: Kazunori
authors.initials: K
authors.lastname: Urabe
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000473:pathology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005121:Extremities; D005148:Facial Dermatoses / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D012720:Severity of Illness Index; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016559:Tacrolimus