title: Efficacy and safety of tacrolimus ointment in pediatric Patients with moderate to severe atopic dermatitis.
abstract: BACKGROUND
  Atopic dermatitis (AD) is an immunological skin disease. It is common in pediatric populations and often requires topical steroid treatment. Moderate to severe AD may not respond to topical steroids. They often require systemic steroids, which may result in growth retardation. Protopic, a non-steroid, tacrolimus based ointment which is a calcinurin inhibitor has been proved to be effective in caucacian with AD.
  
  
  OBJECTIVE
  To evaluate safety and efficacy of 0.03% tacrolimus ointment (Protopic&) in moderate to severe AD in pediatric patients age 2-12 years.
  
  
  METHODS
  This was a one month multicenter open-label clinical trial using tacrolimus ointment twice daily in 61 subjects with moderate to severe AD from September to December 2004. Efficacy assessments were measured by Physician's Global Evaluation of Clinical Response (PhGECR), Eczema area and Severity Index (EASI), Patient's Global Evaluation of Clinical Response (PaGECR), and Quality of Life (QOL). Safety assessment was measured by incidence rate of adverse events.
  
  
  RESULTS
  Fifty-eight patients completed the studies. Twenty-two patients were male; thirty-nine patients were female. Twenty-nine patients had moderate AD. Thirty-two patients had severe AD. Three cases had discontinued treatment at the third week due to increase in severity. Over all PhGECR were significantly increased, 94% showed moderate improvement in PhGECR at week 4 or end of treatment (EOT)and 83% had better improvement in PaGECR at EOT Within 7 days, tacrolimus demonstrated rapid onset in reduction of EASI score and itch in patients. Mean QOL were significantly decreased at the end of the present study. Incidence of adverse events included application site burning (21%), itching (17%), pruritus (9%), infections(3%), and erythema and folliculitis (2%). Burning sensation, erythema, pruritus and itching were resolved after the first week.
  
  
  CONCLUSIONS
  Topical tacrolimus ointment is effective and safe in moderate to severe AD. It significantly improved PhGECR, EASI, PaGECR, and QOL in pediatric patients after the first week of treatment and continued through the end of the study. The major adverse events were burning, itching, and pruritus, which were resolved within the first week of therapy.
authors.affiliation: Dermatology Unit, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
authors.forename: Srisuphaluk
authors.initials: S
authors.lastname: Singalavanija
authors.forename: Noppadon
authors.initials: N
authors.lastname: Noppakun
authors.forename: Wanida
authors.initials: W
authors.lastname: Limpongsanuruk
authors.forename: Wanee
authors.initials: W
authors.lastname: Wisuthsarewong
authors.forename: Kobkul
authors.initials: K
authors.lastname: Aunhachoke
authors.forename: Amornsri
authors.initials: A
authors.lastname: Chunharas
authors.forename: Siriwan
authors.initials: S
authors.lastname: Wananukul
authors.forename: Rutsanee
authors.initials: R
authors.lastname: Akaraphanth
mesh_terms: D000287:Administration, Topical; D002648:Child; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009824:Ointments; D011788:Quality of Life; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus