title: Recommendations for pimecrolimus 1% cream in the treatment of mild-to-moderate atopic dermatitis: from medical needs to a new treatment algorithm.
abstract: Pimecrolimus 1% cream is an effective, non-corticosteroid, topical anti-inflammatory treatment for atopic dermatitis (AD). The aim of this article was to review published clinical data that have examined how pimecrolimus can address the medical needs of AD patients. Clinical studies have demonstrated that early treatment with pimecrolimus decreases the progression to disease flares, rapidly improves pruritus and significantly enhances quality of life. Patients find the formulation easy to apply, which may result in improved adherence with the treatment regimen. Pimecrolimus, in contrast to topical corticosteroids (TCSs), does not induce skin atrophy or epidermal barrier dysfunction and is highly effective for the treatment of AD in sensitive skin areas. Furthermore, pimecrolimus reduces the incidence of skin infections compared with TCSs and is not associated with other TCS-related side effects such as striae, telangiectasia and hypothalamic-pituitary-adrenal axis suppression. An additional benefit of pimecrolimus is its substantial steroid sparing effect. On the basis of these data, a new treatment algorithm for patients with mild-to-moderate AD is proposed in which pimecrolimus is recommended as a first line therapy for patients with established mild AD at the first signs and symptoms of disease. Pimecrolimus is also recommended for mild-to-moderate AD after initial treatment with a TCS. After resolution of lesions, maintenance treatment with pimecrolimus may effectively prevent subsequent disease flares. In conclusion, the clinical profile of pimecrolimus suggests that it may be considered the drug of choice for the treatment of mild-to-moderate AD in children as well as adults and particularly in sensitive skin areas.
authors.affiliation: Department of Dermatology, University of Münster, von-Esmarch-Str. 58, 48149 Münster, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Luger
authors.affiliation: Department of Dermatology, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Linda
authors.initials: L
authors.lastname: De Raeve
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, Ospedale Maggiore Policlinico, Clinica Dermatologica Via Pace, 9 - 20122 Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gelmetti
authors.affiliation: First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
authors.forename: Talia
authors.initials: T
authors.lastname: Kakourou
authors.affiliation: Department of Dermatology, University of Athens, A. Syggros Hospital, Dragoumi 5, 16121 Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Katsarou
authors.affiliation: Department of Dermatology, University Hospital of Antwerp, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Department of Dermatology, Universitaire Ziekenhuizen Leuven and Catholic University of Leuven, Kapucijnenvoer 33, B-3000 Leuven, Belgium.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Morren
authors.affiliation: Department of Pediatrics, Division of Pediatric Dermatology, Erasmus MC - Sophia Children's Hospital, dr. Molewaterplein 60, 3015 GJ, Rotterdam, the Netherlands.
authors.forename: Arnold
authors.initials: A
authors.lastname: Oranje
authors.affiliation: Medical center Le Bâteau-Blanc, Chemin de Paradis, 13500 Martigues, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Ruer
authors.affiliation: Department of Dermatology, Cerrahpasa Medical Faculty, University of Istanbul, Fatih, 34098, Istanbul, Turkey.
authors.forename: Server
authors.initials: S
authors.lastname: Serdaroglu
authors.affiliation: Department of Dermatology, Hospital Niño Jesus, Avenida Menendez Pelayo 65, 28009-Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torrelo
authors.affiliation: Department of Dermatology and Allergy, Hannover Medical School, OE 6600, Carl-Neuberg-Str. 1, D 30625 Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werfel
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D001284:Atrophy / Q000139:chemically induced; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence; D011788:Quality of Life; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*; D063465:Skin Cream / Q000627:therapeutic use*; D016559:Tacrolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; C117268:pimecrolimus; D016559:Tacrolimus
keywords: atopic dermatitis; pimecrolimus; topical calcineurin inhibitor; topical corticosteroid; treatment algorithm