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Eczema: no tacrolimus

Immunosuppressants in ointment form present a negative benefit-risk balance, and carry a risk of skin cancer in particular. It is better not to use them.

The September issue of la revue Prescrire regrets that two immunosuppressant ointments remain on the European market, tacrolimus and pimecrolimus, used for atopic eczema (or atopic dermatitis), whereas their benefit-risk balance is clearly negative and there are other effective treatments.

The treatment of atopic eczema relies first of all on simple measures such as eliminating the irritants, the application of moisturising creams, etc. When these measures prove insufficient, the first-line drug treatment is a topical corticosteroid. Tacrolimus and pimecrolimus are authorised for this indication, but these immunosuppressants are less effective than corticosteroids, and they can have frequent, major adverse effects, including the risk of skin cancer.

La revue Prescrire condemns the European health authorities for being content with the inclusion of warning and coy mentions of the risk of cancer in the patient leaflet, buried among other precautions. It would be better, in the interests of patients, to withdraw these two immunosuppressant ointments, given their clearly negative benefit-risk balance.

©Prescrire Septembre 2007

Source: "Tacrolimus topique : risques de cancers" Rev Prescrire 2007 ; 27 (287) : 667.

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