english.prescrire.org > Spotlight > Archives : 2021 > Atopic eczema: avoid tacrolimus (Protopic° and other brands) and pimecrolimus (Elidel°)

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Atopic eczema: avoid tacrolimus (Protopic° and other brands) and pimecrolimus (Elidel°)

In addition to avoiding factors causing skin irritation, the first-line treatment of atopic eczema is still based on application of an emollient and a topical corticosteroid.

Atopic eczema (atopic dermatitis) manifests as dry skin, inflammatory lesions which follow a relapsing course with flares, and sometimes intense pruritus. It usually begins during the first two years of life, and undergoes remission most often before adolescence.

The treatment of atopic eczema is aimed at preventing the exacerbations and relieving the pruritus, without necessarily aiming for complete disappearance of the lesions. The first-line treatment, in addition to avoiding factors causing skin irritation, is based on application of an emollient and a topical corticosteroid, especially during flares. The patient’s age, and the severity and localisation of the lesions guide the choice of topical corticosteroid. The adverse effects of topical corticosteroids are mainly localised to the application zone. They also expose patients to the systemic adverse effects of corticosteroids, at a frequency dependent on the extent of systemic absorption.

Tacrolimus (Protopic° and other brands) and pimecrolimus (Elidel°) by topical administration are immunosuppressive drugs authorised for the treatment or prevention of eczema flares in children over 2 years of age and in adults.

According to a systematic review of thirteen randomised trials, the efficacy of tacrolimus and pimecrolimus in patients with moderate to severe atopic eczema is no greater than that of a topical corticosteroid. There has been almost no evaluation of their use in situations where topical corticosteroids have failed. The local adverse effects of tacrolimus and pimecrolimus, such as irritation, pruritus and infection, appear to be more frequent than those of topical corticosteroids.

The increased risk of lymphoma and skin cancers and the fact that there is no improvement in efficacy, justify continuing to avoid these two drugs in atopic eczema.

©Prescrire 1 March 2021

Source: "Atopic eczema. Continue to avoid tacrolimus and pimecrolimus" Prescrire International 2021; 30 (224): 75-76. Subscribers only.

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See also:

"Drugs to avoid in the
name of better patient care
- 2021 update"
(February 2021)
Free

"Atopic eczema: avoid
topical tacrolimus"
(October 2012)
Free

"Eczema: no tacrolimus"
(September 2007)
Free


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