How effective are topical calcineurin inhibitors in the treatment of pediatric atopic dermatitis (AD)?

Updated: Jun 03, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Topical calcineurin inhibitors (eg, tacrolimus, pimecrolimus) are the newest class of topical medications for atopic dermatitis. These nonsteroidal immunomodulators act by down-regulating the mediator release or cytokine expression of various cells, including Th1 helper cells, Th2 helper cells, mast cells, eosinophils, keratinocytes, and Langerhans cells. Calcineurin inhibitors may be especially useful for treating face, groin, or axillary areas, where steroid-sparing treatments are preferred. The safety of pimecrolimus has been stressed for infants and other children, with the conclusion made that labeling restrictions be lifted. [53]  Calcineurin inhibitors and corticosteroids have similar benefit, but the former is more expensive and may produce skin burning and pruritus. [49]

Several studies have documented the rapid and prolonged improvement in clinical severity scores in children and adults with a range of severity of atopic dermatitis treat with topical calcineurin inhibitors. Research has shown the beneficial effect of topical calcineurin inhibitors in patients refractory to topical corticosteroid therapy. [54, 55] The most common adverse effect is a local burning sensation upon application, but this symptom tends to diminish after the first few days of use.


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