11/4/03 Atopic dermatitis treatment with tacrolimus ointmentSummaryTacrolimus (Tac) ointment was the first of a new class of non-steroidal topical immunomodulators. Top Tac treatment of atopic dermatitis (AD) has now been assessed in over 16,000 patients. The results of those trials were reviewed by Kapp et al of the Hannover Medical Univ. in Germany. Bases on studies of the effects of 0.03% and 0.1% Tac in AD in adults and children > 24 months old, one can conclude that Tac is rapidly effective in most cases, resulting in improvement starting within 3 days of treatment. There is progressively greater improvement with continued therapy with reduction of AD flares and good chances for long-term disease control. Tac ointment is generally well tolerated without serious systemic adverse effects. There is mild-to-moderate (generally transient) burning, itching and erythema at the application sites. The authors concluded that topical Tac treatment is a significant advance in the treatment of AD and certain other inflammatory skin diseases. It provides clinicians with a reasonable and safer alternative to topical corticosteroid therapy in such disorders. Reference J Dermatolog Treatment 2003;14(Suppl 1):5-16 Editor's Comments The opinions of these authors appears to be similar to that expressed in earlier reviews of Tac effects in Ad (J Am Acad Derm 2002;46:228-41; Exp Opin Pharmacotherapy 2001;2:1167-75). Tac used in 0.1% ointment formulation appears to be more effective than 0.03% Tac for more severe AD. Transient itching and burning occurs commonly at the application sites. Vasiculobullous reactions occur at application sites in <5% of treated individuals. It may be prudent to avoid using topical Tac in those with active or recent herpetic skin manifestations. Topical Tac may be more effective than topical treatment with pimecrolimus, a related compound, but may cause local adverse symptoms more frequently than does pimecrolimus.
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