[Topical immunomodulators, such as tacrolimus and pimecrolimus, in the treatment of atopic dermatitis].
Atopic dermatitis is a chronic inflammatory skin disease with a relapsing course. Topical corticosteroids are the usual treatment of atopic dermatitis. Long-term use of topical corticosteroids may lead to local side effects, such as skin atrophy, and systemic side effects, such as induction of hypothalamus-pituitary-adrenal axis suppression. Tacrolimus and pimecrolimus are new topical immunosuppressive drugs known as topical immunomodulators (TIMs). Clinical efficacy of these drugs has been demonstrated in various long- and short-term placebo-controlled studies. The efficacy oftacrolimus is comparable to a class 2 dermatocorticosteroid and the efficacy of pimecrolimus is comparable to a class 1 dermatocorticosteroid. A major advantage of the use of TIMs is that they do not result in skin atrophy. Tacrolimus may cause local irritation, which mostly disappears after 2 weeks. Little is known about the long-term safety of TIMs. It is expected that TIMs will have an important role in the treatment of mild to moderate atopic dermatitis. Combined treatment with dermatocorticosteroids and TIMs needs further investigation. For patients with severe atopic dermatitis, the addition of TIMs to oral immunosuppressive drugs, such as cyclosporin, may allow for dose reductions of oral medication.
de Bruin-Weller
M S
MS
Universitair Medisch Centrum Utrecht, afd. Dermatologie/Allergologie, Heidelberglaan 100, 3584 CX Utrecht. m.s.debruin-weller@azu.nl
Bruijnzeel-Koomen
C A F M
CA
D000287:Administration, Topical; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009824:Ointments; D016559:Tacrolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016896:Treatment Outcome
D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D009824:Ointments; C117268:pimecrolimus; D016559:Tacrolimus