title: Tacrolimus ointment: utilization patterns in children under age 2 years.
abstract: Atopic dermatitis (AD) is a common eczematous skin condition; as many as 10-17 percent of all children are affected, and 35-60 percent of affected patients manifest symptoms manifest during the first year of life. Treatment principles for AD in young children involve conservative measures such as avoidance of hot water and environmental irritants, combined with liberal use of emollients after bathing. Low potency topical corticosteroids (TCS) are the current standard of therapy for AD in young children, reserving mid- and high-potency TCS for severe disease. However, complications of long-term use of TCS include skin atrophy, stria formation, telangiectasia, hypopigmentation, secondary infections, steroid acne, allergic contact dermatitis, and miliaria. The pediatric population is also at increased risk for systemic absorption because of their high ratio of skin surface to body mass. Systemic absorption may result in hypothalamic-pituitary-adrenal axis suppression and ultimately growth retardation. Although most topical and systemic corticosteroids are not approved by the Food and Drug Administration for use in children less than 2 years of age, conservative treatment often fails in this age group and frequently patients are treated with TCS, antibiotics, and antihistamines.
authors.affiliation: Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Tamara Salam
authors.initials: TS
authors.lastname: Housman
authors.forename: Amy B
authors.initials: AB
authors.lastname: Norton
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
authors.forename: Jon M
authors.initials: JM
authors.lastname: Hanifin
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Antaya
mesh_terms: D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D017723:Drug Utilization Review; D004643:Emollients / Q000627:therapeutic use; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009824:Ointments; D010146:Pain / Q000139:chemically induced; D011537:Pruritus / Q000139:chemically induced; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D004643:Emollients; D006634:Histamine H1 Antagonists; D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus